Enker W E, Stearns M W, Janov A J
Dis Colon Rectum. 1985 Aug;28(8):576-81. doi: 10.1007/BF02554147.
Since 1978, 41 patients (12 percent of all restorative operations) have undergone peranal coloanal reconstruction following anterior resection (LAR) for cancers of the midrectum. Twenty-seven patients (66 percent) were men and 14 patients (34 percent) were women (mean, 58.8 years). The mean distance of the primary tumor from the anal verge was 6.7 cm and 50 percent of the primary tumors were considered highly mobile. In 29 patients, a hand-sewn anastomosis was performed between the colon and the dentate line. In the 12 most recent patients, the anastomosis was performed using a circular stapling instrument. A diverting colostomy should be employed in all cases and is closed approximately three months later. There has been no operative mortality. Morbidity included anastomotic separation (two patients), minor anastomotic defects (three patients), pelvic sepsis (two patients), and bacteremia of unknown origin (two patients). Where fecal diversion was employed, there were no instances of anastomotic leak. Two patients with hemorrhage were returned to the operating room. Thirty-seven of the 41 patients underwent curative resections. Thirty-three percent of the patients had Dukes' C lesions. With a median follow-up of 31 months for the curative resections, 73 percent remain free of disease. Sixty-four percent of evaluable patients have either excellent or good anorectal function nine to 12 months after colostomy closure. Of 26 operations performed by one surgeon, 22 patients (85 percent) are currently evaluable. Nineteen (86 percent) of the 22 have normal or near-normal bowel function. Four guidelines for performing a functionally successful operation are presented. Coloanal reconstruction following LAR, were pull-through operations were previously required, is an excellent sphincter-preserving operation. The functional results one year after the operation are gratifying, with the majority of patients leading an active life with normal bowel function.
自1978年以来，41例患者（占所有修复性手术的12%）在接受低位前切除术（LAR）治疗直肠中段癌后接受了经肛门结肠肛管重建术。27例患者（66%）为男性，14例患者（34%）为女性（平均年龄58.8岁）。原发肿瘤距肛缘的平均距离为6.7 cm，50%的原发肿瘤被认为活动度高。29例患者在结肠与齿状线之间进行了手工缝合吻合。在最近的12例患者中，使用圆形吻合器进行吻合。所有病例均应采用转流性结肠造口术，约3个月后关闭。无手术死亡病例。并发症包括吻合口裂开（2例）、轻微吻合口缺损（3例）、盆腔感染（2例）和不明原因的菌血症（2例）。采用粪便转流时，无吻合口漏病例。2例出血患者返回手术室。41例患者中有37例接受了根治性切除。33%的患者有Dukes' C期病变。根治性切除患者的中位随访时间为31个月，73%的患者仍无疾病复发。64%的可评估患者在结肠造口关闭9至12个月后肛门直肠功能为优或良。在一位外科医生进行的26例手术中，22例患者（85%）目前可进行评估。22例患者中有19例（86%）肠道功能正常或接近正常。本文提出了四项功能性成功手术的指导原则。在以前需要拖出手术进行LAR术后的结肠肛管重建术是一种优秀的保留括约肌手术。术后一年的功能结果令人满意，大多数患者过着积极的生活，肠道功能正常。
