Department of Surgery, St Mark's Hospital and Academic Institute, London, UK.
Colorectal Dis. 2014 Apr;16(4):253-8. doi: 10.1111/codi.12532.
Pull-through with colo-anal sleeve anastomosis may be used as a last resort to avoid permanent diversion in patients with complex rectal conditions. This procedure allows the preservation of intestinal continuity by minimizing the hazards of deep dissection in an inflamed and fibrosed pelvis.
A retrospective study was performed of colo-anal pull-through procedures carried out between January 1998 and December 2012 at St Mark's Hospital by one surgeon. Patients were identified from operative logbooks and their case notes were reviewed. Thirty-four patients (21 women) with a median age of 54 (21-75) years underwent the pull-through operation for complex rectal conditions involving fistulae and/or a hostile pelvis as a final attempt to restore intestinal continuity.
The median length of hospital stay was 7.5 (5-45) days. Median follow-up was 23 (3-71) months. There was no peri-operative mortality. There were two (6%) outright failures. Early complications occurred in 14 (41%) patients and late complications in 10 (29%). Fistulae recurred in seven (25%) of 28 patients but with further treatment four healed, giving an overall healing rate of 89%. Normal continence was achieved in 19 (79%) of 24 patients who were evaluated.
In clinically difficult rectal situations the colo-anal pull-through procedure is a suitable salvage procedure to restore intestinal continuity before considering a permanent stoma.
经结肠直肠套入吻合术（colo-anal sleeve anastomosis）可作为避免复杂直肠疾病患者永久性转流的最后手段。该手术通过最大限度地减少在发炎和纤维化骨盆中深部解剖的危险，保留肠道连续性。
对 1998 年 1 月至 2012 年 12 月间由一位外科医生在圣马克医院（St Mark's Hospital）进行的结肠直肠套入吻合术进行了回顾性研究。从手术日志中确定了患者，并对他们的病历进行了审查。34 名（21 名女性）患者，年龄中位数为 54 岁（21-75 岁），患有涉及瘘管和/或敌对骨盆的复杂直肠疾病，作为恢复肠道连续性的最后尝试，接受了套入吻合术。
中位住院时间为 7.5 天（5-45 天）。中位随访时间为 23 个月（3-71 个月）。无围手术期死亡。有两例（6%）完全失败。14 例（41%）患者发生早期并发症，10 例（29%）发生晚期并发症。28 例患者中有 7 例（25%）瘘管复发，但经进一步治疗，4 例愈合，总愈合率为 89%。24 例接受评估的患者中有 19 例（79%）获得了正常的控便能力。
在临床困难的直肠情况下，结肠直肠套入吻合术是恢复肠道连续性的一种合适的挽救性手术，在考虑永久性造口术之前。
