论文部分内容阅读
目的:肛管、直肠癌扩大根治切除的同时,利用股薄肌肛门成形,以取得肛门节制力,避免了腹壁人工肛门。方法:肛管、直肠癌扩大根治切除,将结肠拉至会阴部并将已从右大腿游离好的股薄肌环绕一周并固定于右坐骨结节。肌肉、肠管间断缝合后肠管断端与会阴部皮肤间断缝合。结果:12例术后三个月肛门功能I级(排便如常人);3例功能为II级;2例III级;1例围手术期死亡。结论:肛管、直肠癌扩大根治切除(R3手术),手术彻底,不影响生存期。利用股薄肌移植,于原肛门处形成一有节制力的新肛门,尽管手术有相当的难度,但只要掌握住拉出肠管血循良好、环绕的股薄肌又不致过紧造成远端肠管坏死,而导致手术失败,则不仅保证了患者的生存期,又在原位形成一个有节制力的肛门,应是值得提倡、推广的手术。
Objective: Anal, colorectal cancer to expand the radical resection at the same time, the use of thin gracilis anus forming, to obtain anal control, to avoid artificial anus abdomen. METHODS: An extended radical resection of the anal and rectal cancers was performed. The colon was pulled to the perineum and the gracilis muscle that had been free from the right thigh was looped around and fixed to the right ischial tuberosity. Muscle, intermittent intestine after intestinal sutures intermittent perineal skin and perineal suture. Results: 12 cases of anal function grade I (defecation as normal) three months after surgery; three cases of function as grade II; two cases of grade III; one case of perioperative death. Conclusion: Anal canal, rectal cancer expand radical resection (R3 surgery), surgery completely, does not affect the survival time. The use of gracilis muscle grafts, in the original anus to form a new force-controlled anus, although the surgery has considerable difficulty, but as long as the blood drawn out of the bowel good blood circulation, around the thin gravis and not cause excessive distal intestinal Necrosis, which led to the failure of surgery, not only to ensure the survival of patients, but also in situ to form a controlled anal, should be worth promoting, promotion of surgery.