Inglin Roman A, Eberli Daniel, Brügger Lukas E, Sulser Tullio, Williams Norman S, Candinas Daniel
Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Freiburgstrasse 10, CH-3010, Bern, Switzerland,
Int J Colorectal Dis. 2015 Mar;30(3):293-302. doi: 10.1007/s00384-014-2065-x. Epub 2014 Nov 19.
Many rectal cancer patients undergo abdominoperineal excision worldwide every year. Various procedures to restore perineal (pseudo-) continence, referred to as total anorectal reconstruction, have been proposed. The best technique, however, has not yet been defined. In this study, the different reconstruction techniques with regard to morbidity, functional outcome and quality of life were analysed. Technical and timing issues (i.e. whether the definitive procedure should be performed synchronously or be delayed), oncological safety, economical aspects as well as possible future improvements are further discussed.
A MEDLINE and EMBASE search was conducted to identify the pertinent multilingual literature between 1989 and 2013. All publications meeting the defined inclusion/exclusion criteria were eligible for analysis.
Dynamic graciloplasty, artificial bowel sphincter, circular smooth muscle cuff or gluteoplasty result in median resting and squeezing neo-anal pressures that equate to the measurements found in incontinent patients. However, quality of life was generally stated to be good by patients who had undergone the procedures, despite imperfect continence, faecal evacuation problems and a considerable associated morbidity. Many patients developed an alternative perception for the urge to defecate that decisively improved functional outcome. Theoretical calculations suggested cost-effectiveness of total anorectal reconstruction compared well to life with a permanent colostomy.
Many patients would be highly motivated to have their abdominal replaced by a functional perineal colostomy. Given the considerable morbidity and questionable functional outcome of current reconstruction technique improvements are required. Tissue engineering might be an option to design an anatomically and physiologically matured, and customised continence organ.
全球每年有许多直肠癌患者接受腹会阴联合切除术。人们提出了各种恢复会阴（假性）控便功能的手术方法，即全肛管直肠重建术。然而，最佳技术尚未明确。本研究分析了不同重建技术在发病率、功能结局和生活质量方面的差异。还进一步讨论了技术和时机问题（即确定性手术应同期进行还是延迟进行）、肿瘤学安全性、经济方面以及未来可能的改进。
进行了MEDLINE和EMBASE检索，以确定1989年至2013年间相关的多语言文献。所有符合定义的纳入/排除标准的出版物均纳入分析。
动态股薄肌成形术、人工肛门括约肌、环形平滑肌套或臀大肌成形术导致的新肛门静息和收缩压力中位数与大便失禁患者的测量值相当。然而，尽管控便功能不完善、排便问题较多且相关发病率较高，但接受这些手术的患者普遍表示生活质量良好。许多患者对排便冲动形成了另一种认知，这显著改善了功能结局。理论计算表明，与永久性结肠造口术相比，全肛管直肠重建术具有成本效益。
许多患者会非常积极地选择用功能性会阴造口替代腹部造口。鉴于当前重建技术存在较高的发病率且功能结局存疑，需要进行改进。组织工程可能是设计解剖学和生理学上成熟的定制控便器官的一种选择。
