Nitta Toshikatsu, Ishii Masatsugu, Kataoka Jun, Senpuku Sedakatsu, Ueda Yasuhiko, Iida Ryo, Matsutani Ayumi, Ishibashi Takashi
Division of Surgery Gastroenterological Center Medico Shunju Shiroyama Hospital, Osaka, Japan.
Ann Med Surg (Lond). 2021 Nov 5;72:103005. doi: 10.1016/j.amsu.2021.103005. eCollection 2021 Dec.
Dysfunctions such as mucosal prolapse occur after intersphincteric resection (ISR) to treat lower rectal cancer, even when it is possible to preserve the anus.
We analyzed the data of 12 patients with rectal or colonic prolapse who underwent the Gant-Miwa-Thiersch procedure between March 2017 and May 2021.
There were no severe postoperative complications or recurrences.
A 75-year-old Japanese man initially underwent ISR and had mucosal prolapse nine months after his initial operation. We performed the Gant-Miwa-Thiersch procedure for colonic mucosal prolapse after ISR.
Our procedure is a perineal plication method of prolapsed colonic mucosa with nylon wiring (The Gant-Miwa procedure), using a 1-nylon wire encircled three times to straighten the anal canal, with a cord inserted above the internal sphincter muscle (Thiersch procedure).
Mucosal plication is performed via the Gant-Mowa or Delorme procedure to reduce the risk of recurrence. However, mucosal plication can be performed many times. Our Thiersch procedure involves encircling and straightening the anal canal with a 1-nylon wire to fix the new internal anal sphincter. In conclusion, the Gant-Miwa-Thiersch procedure for rectal and colonic mucosal prolapse, especially after ISR, is a viable treatment option.
即使在能够保留肛门的情况下，行括约肌间切除术（ISR）治疗低位直肠癌后仍会出现诸如黏膜脱垂等功能障碍。
我们分析了2017年3月至2021年5月间接受甘特-三泽-蒂尔施手术的12例直肠或结肠脱垂患者的数据。
术后无严重并发症或复发情况。
一名75岁的日本男性最初接受了ISR手术，术后9个月出现黏膜脱垂。我们对ISR术后结肠黏膜脱垂患者实施了甘特-三泽-蒂尔施手术。
我们的手术是一种采用尼龙线对脱垂结肠黏膜进行会阴折叠的方法（甘特-三泽手术），使用一根尼龙线环绕三次以拉直肛管，并在内括约肌上方插入一根线绳（蒂尔施手术）。
通过甘特-莫瓦或德洛姆手术进行黏膜折叠以降低复发风险。然而，黏膜折叠可以多次进行。我们的蒂尔施手术包括用一根尼龙线环绕并拉直肛管以固定新的肛门内括约肌。总之，对于直肠和结肠黏膜脱垂，尤其是ISR术后的情况，甘特-三泽-蒂尔施手术是一种可行的治疗选择。
