Department of General Surgery, Universidad Pontificia Bolivariana, Clínica de Las Américas, Diagonal 75B #2A-80/308, Medellín, Colombia.
Tech Coloproctol. 2013 Aug;17(4):425-9. doi: 10.1007/s10151-012-0961-z. Epub 2012 Dec 15.
Our aim was to evaluate complications and long-term functional outcome in patients who had sphincter reconstruction using the gluteus maximus muscle as the neosphincter after abdominoperineal resection for rectal cancer treatment.
Seven patients underwent reconstruction from 2000 to 2010. First, the sigmoid colon was brought down to the perineum as a perineal colostomy, with the procedure protected by a loop ileostomy. Reconstruction of the sphincter mechanism using the gluteus maximus took place 3 months later, and after another 8-12 weeks, the loop ileostomy was closed. We studied the functional outcome of these interventions with follow-up interviews of patients and objectively assessed anorectal function using manometry and the Cleveland Clinic Florida (Jorge-Wexner) fecal incontinence score.
The mean follow-up was 56 months (median 47; range 10-123 months). One patient had a perianal wound infection and another had fibrotic stricture in the colocutaneous anastomosis that required several digital dilatations. Anorectal manometry at 3-month follow-up showed resting pressures from 10 to 18 mm Hg and voluntary contraction pressures from 68 to 187 mm Hg. Four patients had excellent sphincter function (Jorge-Wexner scores ≤5).
Our preliminary results show that sphincter reconstruction by means of gluteus maximus transposition can be effective in restoring gastrointestinal continuity and recovering fecal continence in patients who have undergone APR with permanent colostomy for rectal cancer. Furthermore, the reconstruction procedure can be performed 2-4 years after the APR.
我们的目的是评估在直肠癌腹会阴切除术后使用臀大肌重建肛门括约肌的患者的并发症和长期功能结果。
2000 年至 2010 年间，有 7 名患者接受了重建。首先，乙状结肠被带到会阴作为会阴结肠造口术，该手术由回肠造口术保护。3 个月后，使用臀大肌重建肛门括约肌机制，再过 8-12 周，关闭回肠造口术。我们通过对患者进行随访访谈来研究这些干预措施的功能结果，并使用直肠测压法和克利夫兰诊所佛罗里达州（Jorge-Wexner）粪便失禁评分客观评估肛门直肠功能。
平均随访时间为 56 个月（中位数 47；范围 10-123 个月）。1 例患者发生肛周伤口感染，另 1 例患者发生结肠皮肤吻合口纤维化狭窄，需要多次手指扩张。3 个月随访时的直肠测压显示静息压力为 10-18mmHg，自愿收缩压力为 68-187mmHg。4 名患者的肛门括约肌功能良好（Jorge-Wexner 评分≤5）。
我们的初步结果表明，通过臀大肌转位重建肛门括约肌可以有效地恢复胃肠道连续性，并在永久性结肠造口术的 APR 后恢复粪便控制。此外，重建手术可以在 APR 后 2-4 年进行。
