Geerdes B P, Zoetmulder F A, Baeten C G
Department of Surgery, Maastricht University Hospital, The Netherlands.
Eur J Cancer. 1995 Jul-Aug;31A(7-8):1248-52. doi: 10.1016/0959-8049(95)00173-g.
In patients with a very low rectal carcinoma, an abdominoperineal resection with the creation of a permanent colostomy is the surgical treatment of choice. Creation of a colostomy can be avoided without compromise to oncological safety. The distal colon is pulled through to the perineum and both gracilis muscles are used to create a new sphincter and pelvic floor. These muscles are electrically stimulated by an implanted neurostimulator. Contraction is then no longer dependent upon volition and, due to fibre transformation, the muscle will become fatigue-resistant. The outcome in 11 patients was assessed. After a mean follow-up of 1.3 years, continence was achieved in 7 patients, and 2 patients are awaiting completion of the therapy. In 2 patients, necrosis of the distal colon led to failure of the technique. There was no local recurrence, but 2 patients had distant metastasis. Double dynamic graciloplasty after abdominoperineal resection proves to be an oncologically safe procedure with a reasonable chance of continence and a life without a stoma in the majority of patients.
对于低位直肠癌患者，经腹会阴联合切除术并建立永久性结肠造口是首选的手术治疗方法。在不影响肿瘤学安全性的情况下，可以避免造口的建立。将远端结肠拉至会阴，利用双侧股薄肌创建新的括约肌和盆底。这些肌肉由植入的神经刺激器进行电刺激。随后收缩不再依赖于意志，并且由于纤维转化，肌肉将变得抗疲劳。对11例患者的治疗结果进行了评估。平均随访1.3年后，7例患者实现了控便，2例患者正在等待治疗完成。2例患者远端结肠坏死导致该技术失败。无局部复发，但有2例患者发生远处转移。经腹会阴联合切除术后的双动力股薄肌成形术被证明是一种肿瘤学安全的手术，大多数患者有合理的控便机会且无需造口生活。
