von Flüe M, Harder F
Department of Surgery, University Hospital Basel, Switzerland.
Dis Colon Rectum. 1994 Nov;37(11):1160-2. doi: 10.1007/BF02049823.
Surgical options in metachronous or recurrent rectal cancer after anterior or low anterior resection are limited and frequently result in abdominoperineal rectal extirpation sacrificing the sphincter or in straight coloanal reconstruction. Decreased capacity and distensibility in straight coloanal reconstruction after proctectomy correlate well with increased daily stool frequency, urgency, and incontinence. A new technique for coloanal pouch reconstruction using the ileocecal segment is proposed.
A pedunculated ileocecal segment was rotated 180 degrees counterclockwise and placed between the sigmoid colon and anal canal. Ileal end of the pouch was then anastomosed end-to-end with the transected sigmoid colon and proximal end of the ileum with distal end of the ascending colon. Functional results and defecation quality of a 67-year-old woman are described 6 and 12 months after ileocolonic interposition pouch replacing the tumor-bearing rectum.
Twelve months postoperatively, the patient is free of disease with an excellent defecation quality, has full anal continence without soiling, is having two solid stools in 24 hours. Functional control revealed normal anal sphincter pressure and large rectal capacity and compliance. Neither outlet obstruction nor incomplete evacuation have been observed.
The ileocecal interposition pouch (cecum pouch) represents an alternative technique for coloanal reconstruction in low rectal cancer, recurrent rectal cancer, or metachronous low rectal cancer with intact sphincter function. This new method presents some attractive features compared with techniques presently in use.
在进行前切除术或低位前切除术后发生异时性或复发性直肠癌时，手术选择有限，且常常导致牺牲括约肌的腹会阴直肠切除术，或导致直结肠肛管重建术。直肠切除术后直结肠肛管重建术的容量和扩张性降低与每日排便次数增加、急迫感和失禁密切相关。本文提出一种使用回盲肠段进行结肠肛管袋重建的新技术。
将带蒂回盲肠段逆时针旋转180度，置于乙状结肠和肛管之间。然后将袋的回肠端与横断的乙状结肠端端吻合，回肠近端与升结肠远端吻合。描述了一名67岁女性在回结肠插入袋替代含肿瘤直肠后6个月和12个月的功能结果及排便质量。
术后12个月，患者无疾病，排便质量极佳，完全肛门节制无污粪，24小时有两次成形大便。功能检查显示肛门括约肌压力正常，直肠容量和顺应性大。未观察到出口梗阻或排空不全。
回盲肠插入袋（盲肠袋）是低位直肠癌、复发性直肠癌或异时性低位直肠癌且括约肌功能完整时进行结肠肛管重建的一种替代技术。与目前使用的技术相比，这种新方法具有一些吸引人的特点。
