Hildebrandt U, Lindemann W, Ecker K W, Walter P
Abteilung für Allgemeine Chirurgie, Abdominal- und Gefässchirurgie, Universitätskliniken des Saarlandes, Homburg/Saar.
Zentralbl Chir. 1994;119(12):886-91.
Low anterior resection of rectal cancer with preservation of the anal sphincter has comparable recurrence and survival rates when compared to abdominoperineal excision. Stool frequency and leakage rates are high after coloanal anastomosis. The colonic J-pouch improves function. Endosonographic tumor stages ES T1 and ES T2 for cancer in the distal third rectum and ES T3 tumors in die middle third rectum are indications for rectal resection with preservation of the sphincter and reconstruction with the colonic pouch. In 33 patients the technique was safe, with no deaths and no reoperation. Three diverting colostomies are not yet closed. 25 patients are perfect continent, two are incontinent for gas, three have minor and one patient major incontinence. Only one patient has more than three bowel movements in 24 hrs. For selected cancers of the distal half of the rectum total resection with preservation of the anal sphincter is a safe operation. Good function is provided by the colon J-pouch.
与腹会阴联合切除术相比,保留肛门括约肌的直肠癌低位前切除术具有相当的复发率和生存率。结肠肛管吻合术后大便频率和渗漏率较高。结肠J形贮袋可改善功能。对于直肠远端三分之一的癌症,内镜超声肿瘤分期为ES T1和ES T2,以及直肠中三分之一的ES T3肿瘤,是保留括约肌并采用结肠贮袋重建进行直肠切除的指征。在33例患者中,该技术是安全的,无死亡病例,也无需再次手术。3个转流性结肠造口尚未关闭。25例患者完全控便,2例患者有气体失禁,3例患者有轻度失禁,1例患者有重度失禁。只有1例患者24小时内排便超过3次。对于部分直肠远端一半的癌症,保留肛门括约肌的全切除术是一种安全的手术。结肠J形贮袋可提供良好的功能。