Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
Dis Colon Rectum. 2011 Jun;54(6):718-28. doi: 10.1007/DCR.0b013e318216ac66.
Innovative techniques created to restore gastrointestinal perineal continuity after abdominoperineal resection in patients with anorectal cancer include pseudocontinent perineal colostomy, in which the colon is pulled to the perineum and wrapped with a sleeve of stretched colon segment to act as a new sphincter.
We investigated perineal reconstruction with a modified pseudocontinent perineal colostomy technique.
Prospective cohort study.
Tertiary care university hospital in Egypt.
Patients with T2 or T3 anorectal cancer invading the sphincter who underwent Miles abdominoperineal resection and immediate total pelvic reconstruction between 2003 and 2007.
Reconstruction consisted of a vertical rectus abdominis myocutaneous flap with modified perineal colostomy pulled through the flap to add the high-pressure zone of the flap to that of the colostomy and to create a persistent new anorectal angle.
Early and late complications were recorded. Functional results were evaluated at regular intervals by questionnaire, physical examination, and balloon manometry. Continence was graded according to Kirwan. Satisfaction with continence was assessed by questionnaire.
A total of 14 patients (3 women) were included. Tumors were adenocarcinoma (n = 11), squamous-cell carcinoma (n = 2), and melanoma (n = 1). Complete (R0) resection was achieved in all patients without perioperative deaths, major postoperative morbidity, or conversion to permanent iliac colostomy. Early postoperative complications (perineal wound infection, flap dehiscence, and partial perineal stoma necrosis) occurred in the first 4 patients. Late complications occurred in 7 patients, with mucosal prolapse in 3, stomal stricture in 4, and tumor recurrence in 1. Fecal continence progressed consistently with time, and by the end of the first year 8 patients (57%) had complete continence (grade A), 5 (36%) were continent with minor soiling (grade C), and 1 (7%) still had major soiling (grade D). After 6 months, 9 patients (64%) were satisfied with continence; after 1 year, 13 patients (93%) were satisfied. Regular enemas were necessary during the first year to improve soiling, and 8 patients (57%) were not in need after that. At 37 months median follow-up, 8 of 9 evaluable patients (89%) were satisfied with continence (grade A) without regular enemas.
This was a preliminary observational study with no control group.
Total orthotopic pelvic reconstruction with autologous tissue transposition to rebuild the principle anorectal continence elements is feasible with minor complications, and is oncologically safe. This new technique offered high continence satisfaction independent of regular enemas and electrical stimulation.
为了在直肠癌患者行腹会阴联合切除术（APR）后恢复会阴肛门连续性，创新性地创造了一些技术，包括假肛会阴结肠造口术，即将结肠拉到会阴并用伸展的结肠段袖套包裹，以充当新的括约肌。
我们研究了一种改良的假肛会阴结肠造口术的会阴重建技术。
前瞻性队列研究。
埃及的一所三级护理大学医院。
2003 年至 2007 年间，接受 Miles 经腹会阴联合切除术和即刻全盆腔重建的 T2 或 T3 侵犯括约肌的肛门直肠癌患者。
重建包括垂直腹直肌肌皮瓣和改良的会阴结肠造口术，将其穿过皮瓣，以增加皮瓣的高压区和结肠造口的高压区，并创建一个持久的新肛直肠角度。
记录早期和晚期并发症。通过问卷调查、体格检查和球囊测压定期评估功能结果。根据 Kirwan 分级评估控便能力。通过问卷调查评估对控便的满意度。
共纳入 14 例患者（3 例女性）。肿瘤为腺癌（n=11）、鳞状细胞癌（n=2）和黑色素瘤（n=1）。所有患者均获得完整（R0）切除，无围手术期死亡、严重术后并发症或转为永久性髂结肠造口术。前 4 例患者出现早期术后并发症（会阴伤口感染、皮瓣裂开和部分会阴造口坏死）。7 例患者出现晚期并发症，其中 3 例出现黏膜脱垂，4 例出现造口狭窄，1 例出现肿瘤复发。粪便控便能力随着时间的推移而持续改善，第 1 年末，8 例（57%）患者完全控便（A级），5 例（36%）患者轻度污染（C 级），1 例（7%）患者重度污染（D 级）。6 个月后，9 例（64%）患者对控便满意；1 年后，13 例（93%）患者满意。第 1 年需要定期灌肠以改善污染，此后 8 例（57%）患者不再需要。中位随访 37 个月时，9 例可评估患者中的 8 例（89%）对控便（A级）感到满意，无需定期灌肠和电刺激。
这是一项初步的观察性研究，没有对照组。
通过使用自体组织移位重建主要肛直肠控便要素的全骨盆重建术是可行的，并发症较少，且在肿瘤学上是安全的。这种新技术提供了高的控便满意度，独立于定期灌肠和电刺激。
