Sato T, Konishi F, Kanazawa K
Department of Surgery, Jichi Medical School, Japan.
Dis Colon Rectum. 1997 Dec;40(12):1497-502; discussion 1502-3. doi: 10.1007/BF02070719.
We report herein a case of a patient with rectal carcinoma in whom a new anus was constructed following an abdominoperineal resection of the anorectum. This is the first reported case in which reconstruction of the anal sphincter was performed using the lower part of the gluteus maximus muscle with a pudendal nerve anastomosis. The pudendal nerve anastomosis maneuver was designed to achieve proper innervation and function of the external anal sphincter. This newly reconstructed sphincter was physiologically evaluated after surgery.
The patient's defunctioning colostomy was not closed following his initial surgery because part of the transposed muscle was devitalized by infection following blood flow damage. However, purposeful contraction of the new sphincter was easy to achieve without special training. The patient's rectal sensation for the desire to defecate was satisfactory. Electromyographic studies demonstrated that the newly reconstructed anal sphincter had characteristics of the original external anal sphincter.
This method is a promising procedure for reconstructing the anal sphincter.
我们在此报告一例直肠癌患者，该患者在腹会阴联合直肠切除术之后进行了新肛门重建。这是首例报道的使用臀大肌下部并吻合阴部神经来重建肛门括约肌的病例。阴部神经吻合操作旨在实现肛门外括约肌的适当神经支配和功能。术后对这个新重建的括约肌进行了生理学评估。
初次手术后患者的功能性结肠造口未关闭，因为移位肌肉的一部分因血流受损后感染而失活。然而，新括约肌无需特殊训练就能轻松实现有目的的收缩。患者对排便欲望的直肠感觉令人满意。肌电图研究表明，新重建的肛门括约肌具有原始肛门外括约肌的特征。
该方法是一种很有前景的肛门括约肌重建手术。
