Yi Bing-qiang, Wang Zhen-jun, Zhao Bo, Wei Guang-hui, Han Jia-gang, Ma Hua-chong, Zhao Bao-cheng
Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Wai Ke Za Zhi. 2013 Jul;51(7):577-81.
To study surgical treatment of postoperative stricture of anastomosis for lower rectal cancer.
The data of 9 cases who were diagnosed as postoperative stricture of anastomosis after operation of intersphincteric resection for lower rectal cancer during January 2008 to June 2011 were analyzed retrospectively. Transanal excision of stricture were used in 3 cases diagnosed as membranous stricture. Transanal radial incision of stricture were used in 5 cases diagnosed as tubulous stricture. Biologic patch was used to repair the defect of the posterior wall of rectum after excision of severe stricture in 1 case.
All 9 cases of postoperative stricture of anastomosis were cured by surgery. Anal dilation were performed every day by patients themselves after discharge. Digital examination showed that 1 to 2 fingers could pass through the anastomosis after operation. The patient whose rectal defect was repaired by biological patch underwent colonoscopy examination two weeks after operation. Colonoscopy showed that the biological patch had been filled with granulation and integrated into the surrounding intestinal tissue. All patients defecated without difficulty and the anal function of all patients was good after restoration of intestinal continuity.
Aggressive surgery, combining with the use of biological patch if necessary is an effective therapy of postoperative stricture of anastomosis for lower rectal cancer.
探讨低位直肠癌术后吻合口狭窄的外科治疗方法。
回顾性分析2008年1月至2011年6月期间因低位直肠癌行括约肌间切除术后诊断为吻合口狭窄的9例患者的资料。3例诊断为膜状狭窄的患者采用经肛门狭窄切除术。5例诊断为管状狭窄的患者采用经肛门狭窄放射状切开术。1例严重狭窄切除术后采用生物补片修复直肠后壁缺损。
9例吻合口狭窄患者均经手术治愈。出院后患者自行每天进行肛门扩张。指诊显示术后吻合口可通过1至2指。直肠缺损采用生物补片修复的患者术后两周行结肠镜检查。结肠镜检查显示生物补片已被肉芽组织填充并融入周围肠组织。所有患者排便均无困难，肠管连续性恢复后所有患者肛门功能良好。
积极手术，必要时联合使用生物补片是治疗低位直肠癌术后吻合口狭窄的有效方法。
