von Flüe M O, Degen L P, Beglinger C, Hellwig A C, Rothenbühler J M, Harder F H
Department of Surgery, Basel University, Switzerland.
Ann Surg. 1996 Aug;224(2):204-12. doi: 10.1097/00000658-199608000-00014.
BACKGROUND/AIMS: After proctectomy for low rectal cancer and straight coloanal reconstruction, the main causes for increased daily stool frequency, urgency, and incontinence are the limited capacity and distensibility of the anastomosed colic segment in the pelvis. The authors postulated that a pedunculated (preserving the nerve) ileocecal interpositional graft (cecum-reservoir) placed between the sigmoid colon and the anal canal would greatly reduce these inconveniences.
The authors evaluated the safety, defecation quality, and anorectal physiology of such a neorectum in 20 consecutive patients with rectal carcinoma between 5 and 10 cm above the anal verge who underwent total mesorectal excision.
No perioperative morbidity related to the technique and no mortality was observed in these 20 patients. Six months after the operation, 16 patients showed excellent and 4 patients good defecation quality, with maximal tolerable volumes, compliance, and mean colonic transit times comparable to age- and gender-matched healthy volunteers. In addition, anal resting pressure was decreased, squeeze pressure was maintained, and the rectoanal inhibitory reflex remained positive in 80%.
The cecum-reservoir as a neorectum, using an intact neurovascular colonic segment, is a safe technique, providing excellent defecation quality. It enables a nearly normal physiologic anorectal function, which is already seen 6 months postoperatively.
背景/目的：低位直肠癌直肠切除术后行直结肠肛管重建，术后每日排便次数增加、便急和大便失禁的主要原因是盆腔内吻合结肠段的容量和扩张性受限。作者推测，在乙状结肠和肛管之间置入带蒂（保留神经）的回盲部间置移植物（盲肠贮袋）可大大减少这些不便。
作者对20例距肛缘5至10厘米的直肠癌患者进行了全直肠系膜切除，评估了这种新直肠的安全性、排便质量和肛肠生理学。
这20例患者未观察到与该技术相关的围手术期并发症，也无死亡病例。术后6个月，16例患者排便质量极佳，4例患者良好，最大耐受容量、顺应性和平均结肠传输时间与年龄和性别匹配的健康志愿者相当。此外，肛门静息压降低，挤压压维持，80%的患者直肠肛门抑制反射仍为阳性。
使用完整神经血管结肠段的盲肠贮袋作为新直肠是一种安全的技术，排便质量极佳。它能实现近乎正常的生理性肛肠功能，术后6个月即可见。
