Fortýn K, Hruban V, Hradecký J, Tichý J, Dvorák P, Horák V
Czechoslovak Academy of Sciences, Department of Genetics, Libĕchov.
Z Exp Chir Transplant Kunstliche Organe. 1989;22(3):173-9.
In 6 laboratory pigs, devascularization (devitalization) of the rectum and the adjacent part of the sigmoideum was carried out by the vasa rectalia cranialia et media ligatures with simultaneous aboral closure of the rectum at the base of the lesser pelvis and oral closure at the borderline between the rectum and the sigmoideum. The devascularized rectum was not removed but left in situ. Terminal colostomy was established. Laparotomic revision was carried out after 12 weeks, colostomy was removed and continuity of the intestine was reestablished by insertion anastomosis, by suture of the end of the colon to the anal mucosa and skin. In further two pigs, devascularization of the rectosigmoideum was carried out with colostomy and reconstruction was carried out after 12 weeks by procto-sigmoideo-anastomosis. In another 2 animals, devascularization was carried out on the lower part of the sigmoideum and continuity was immediately renewed by end-to-side sigmoideo-sigmo-ideoanastomosis. All revisions indicated that the devascularized necrotic segment shrank to form a minute fibrous tissue residue, anastomosis was patent and continence was retained for colo-proctoanastomosis. The described techniques are technically simple and could be employed as palliative surgical methods for inoperable tumours in the region of the rectum and lower part of the sigmoideum.
在6只实验猪中,通过结扎直肠上动脉和直肠中动脉使直肠及乙状结肠相邻部分去血管化(失活),同时在小骨盆底部对直肠进行向肛侧闭合,并在直肠与乙状结肠交界处进行向口侧闭合。去血管化的直肠未被切除,而是留在原位。建立末端结肠造口术。12周后进行剖腹检查,切除结肠造口术,并通过插入式吻合术,将结肠末端与肛门黏膜及皮肤缝合,重建肠道连续性。在另外2只猪中,对直肠乙状结肠进行去血管化并实施结肠造口术,12周后通过直肠乙状结肠吻合术进行重建。在另外2只动物中,对乙状结肠下部进行去血管化,并立即通过乙状结肠侧侧吻合术恢复连续性。所有检查均表明,去血管化的坏死段收缩形成微小的纤维组织残余物,吻合口通畅,结肠直肠吻合术后保持了节制功能。所描述的技术在技术上简单易行,可作为直肠和乙状结肠下部无法手术切除的肿瘤的姑息性手术方法。