Zoetmulder F A, Baris G
Department of Surgery, Netherlands Cancer Institute, Amsterdam.
Dis Colon Rectum. 1995 Jan;38(1):80-4. doi: 10.1007/BF02053864.
A new operation was developed to treat patients with local recurrence of cancer at the anal margin after radiotherapy. This operation aims at resection of the tumor with oncologically safe margins, preservation of fecal continence, and reliable wound healing.
After intensive radiotherapy, three patients with local recurrences of squamous-cell carcinoma of the anus refused to undergo abdominoperineal resection. These patients were treated by wide local excision and primary reconstruction. Wide local excision included perianal skin with subcutis and the anal canal including the internal sphincter up to the dentate line. To reconstruct the anus, the rectum was mobilized and brought down to the level of the perineum through the external sphincter and anastomosed to bilateral biceps femoris myocutaneous flaps.
In the first three patients no tumor recurrences have occurred, and fecal continence has been good.
The first results with this continence-preserving operation in patients with recurrent anal margin cancers after radiotherapy have been encouraging.
开发一种新手术用于治疗放疗后肛门边缘癌局部复发的患者。该手术旨在切除具有肿瘤学安全切缘的肿瘤，保留大便失禁功能，并实现可靠的伤口愈合。
在强化放疗后，3例肛门鳞状细胞癌局部复发的患者拒绝接受腹会阴联合切除术。这些患者接受了广泛局部切除和一期重建治疗。广泛局部切除包括肛周皮肤及皮下组织以及肛管，包括内括约肌直至齿状线。为了重建肛门，游离直肠并通过外括约肌将其下拉至会阴水平，与双侧股二头肌肌皮瓣吻合。
前3例患者未发生肿瘤复发，大便失禁功能良好。
放疗后复发性肛门边缘癌患者采用这种保留大便失禁功能的手术取得的初步结果令人鼓舞。
