直肠癌根治会阴部造口术后二期股薄肌移植肛门成形

目的回顾性总结32例直肠癌根治会阴部造口术后二期股薄肌移植肛门成形术的治疗效果。方法采用Williams5级评分法对重建前后肛门功能进行评价。结果二期股薄肌移植肛门成形术前，32例患者肛门功能均在4级以上[4级28．4％(9／32)，5级71.6％(23／32)]，二期股薄肌移植肛门成形术后肛门功能明显好转。结论二期股薄肌移植肛门成形术是直肠癌根治会阴部造口术后有效的肛门重建手段。     

直肠癌根治术后股薄肌移转肛门成形16例

为１６例直肠癌病人，行根治术后，即时经Ｍｉｌｅｓ手术建立直肠角，以带血管神经蒂的股薄肌移转替代肛门托约肌，在原位重建肛门、保持了肛门的正常位置和排便自控功能，效果满意，原位重建肛门，恢复了括约肌功能，减轻了病人痛苦。     

直肠癌根治术后股薄肌移转肛门成形16例

为16例直肠癌病人,行根治术后,即时经 Miles 手术建立直肠角,以带血管神经蒂的股薄肌移转替代肛门括约肌,在原位重建肛门,保持了肛门的正常位置和排便自控功能,效果满意。原位重建肛门,恢复了括约肌功能,减轻了病人痛苦。     

直肠癌根治术后股薄肌移转肛门成形16例

为１６例直肠癌病人，行根治术后，即时经Ｍｉｌｅｓ手术建立直肠角，以带血管神经蒂的股薄肌移转替代肛门括约肌，在原位重建肛门，保持了肛门的正常位置和排便自控功能，效果满意。原位重建肛门，恢复了括约肌功能，减轻了病人痛苦     

电刺激股薄肌肛门成形术

保护和恢复对大便的控制能力一直是肛肠外科需要解决的问题，现腹会阴联合直肠癌切除永久结肠造瘘和肛门失禁依然困扰人类健康，电刺激股薄肌肛门成形术是一种新的术式，本文就其手术相关问题进行综述。     

双侧股薄肌代括约肌原位肛门再造术的疗效分析

目的 研究双侧股薄肌代括约肌原位肛门再造术在低位直肠癌术后控制排便的治疗效果。方法 通过近10年来诊治低位直肠癌56例病人,采用双侧股薄肌代括约肌原位肛门再造术,并制定肛门排便功能的临床评定标准,以8分法进行评定,8～6分为优.6～4分为良.4～2分为差.2～0分为无效。术后随访客观分析其疗效。结果 根据评定标准56例病人中优32例,良17例,差5例,无效2例,我们把优及良病例定为有效,总有效率为87.5％。结论 双侧股薄肌代括约肌原位肛门再造术疗效可靠,是人工肛门手术方式中较理想、较科学的术式之一。     

股薄肌肛门原位成形术治疗肛门失禁的临床观察

目的探讨股薄肌肛门原位成形术(GP)治疗肛门失禁的疗效及其并发症。方法回顾性分析2007年6月至2010年12月在中山大学附属第六医院行GP治疗5例肛门失禁患者的临床资料。结果术后伤口愈合时间32d(24～51d)。术后无明显并发症,术后3个月和术后1年的Wexner评分分别为8.0±0.4分和6.8±1.4分。术前术后肛管直肠动力学比较发现:术后患者的肛管静息压和肛管长度较术前明显改善(P<0.05)。结论 GP对肛门失禁的疗效好,并可以维护肛门功能及肛门外形。     

电刺激股薄肌肛门成形术(文献综述)

保护和恢复对大便的控制能力一直是肛肠外科需要解决的问题。现腹会阴联合直肠癌切除永久结肠造瘘和肛门失禁依然困扰人类健康。电刺激股薄肌肛门成形术是一种新的术式 ,本文就其手术相关问题进行综述     

二期手术建立电刺激股薄肌成形术原位肛门重建的犬实验模型

我们采用二期手术法。建立了原位肛门重建的犬电刺激股薄肌成形术(dynamic graciloplasty，DGP)模型。     

Circumferential resection margin involvement after laparoscopic abdominoperineal excision for rectal cancer

Aim This study aimed to evaluate circumferential resection margin (CRM) involvement in patients with rectal adenocarcinoma after laparoscopic abdominoperineal excision (APR). Method Prospectively collected data were analyzed on consecutive patients who underwent laparoscopic APR for histologically proven rectal cancer following neoadjuvant chemotherapy, from 1998 to 2006. Patients with no sphincter involvement were not included and underwent intersphincteric resection with coloanal anastomosis. CRM involvement was defined as ≤ 2 mm using a standardized pathology protocol. Data were presented as mean ± SD or as median (range). Results Seventy‐four patients (60 ± 14 years of age; body mass index = 29.7 ± 7.9 kg/m²) underwent laparoscopic APR. The distance of the tumour from the anal verge was 3.1 ± 0.93 cm. All patients had sphincter involvement. The operative time was 180 ± 73 min, and estimated blood loss was 269 ± 149 ml. There were no conversions and no postoperative mortality. The adverse event rate was 11%. There were two reoperations and three readmissions. Seventy‐one patients had a T3 tumour and three patients had a T4 tumour. The median tumour size was 3.1 (range, 0–10) × 3 (range, 0–8.5) × 2 (range, 0–3.6) cm, and 26 (range, 3–41) lymph nodes were harvested. The median CRM was 7 (range, 1–11) mm. This was localized at the waist of the specimen in 12 (16.2%) of patients. Adjuvant therapy was given to 92% and 97% of patients with an involved and an uninvolved CRM, respectively. At 50 ± 27 months of follow up of 73 patients, 12 had CRM involvement and had a significantly decreased cancer‐specific survival (log rank test, P = 0.002). Conclusion Laparoscopic APR resulted in CRM involvement in 16.2% of patients with rectal cancer.     

大网膜移植促进直肠癌腹会阴联合根治术后会阴伤口的愈合

目的　探讨游大网膜移植促进直肠癌腹会阴联合根治术后会阴伤口愈合的可行性。　方法　1998年 3月～ 10月 ,将 31例直肠癌患者随机分为治疗组 :按根治原则完成腹会阴联合根治术加游离的大网膜片移植于会阴伤口 (12例 )和对照组 :常规腹会阴联合根治术 (19例 )。观察比较两组患者术后体温变化 ,会阴伤口引流量 ,术后住院日和会阴伤口I期愈合情况及随诊结果。　结果　治疗组和对照组的术后发烧为8.3%比 36 .8% (x2 =3.13,P >0 .0 5 ) ;会阴伤口引流量为 110ml比 186 .4ml(t=5 .10 ,P <0 .0 1) ;术后住院日为18.2天比 2 5 .0天 (t=2 .5 6 ,P <0 .0 5 )和会阴伤口I期愈合率为 91.7%比 10 .5 % (x2 =19.89,P <0 .0 1)。术后3年随诊结果无差异。　结论　游离大网膜移植于会阴伤口 ,具有减少术后伤口感染 ,减轻患者痛苦 ,提高I期愈合率 ,缩短住院时间的优点 ,是一简便可行的方法     

经腹-会阴联合直肠癌根治术后经腹膜外造口对患者旁疝与排便功能的影响

目的探讨经腹-会阴联合直肠癌根治术后经腹膜外造口对患者旁疝与排便功能的影响。 方法选择2016年1月至2017年6月,广元市中心医院行经腹-会阴联合直肠癌根治术78例患者的临床资料。其中经腹膜外造口者40例为观察组,经腹膜内造口者38例为对照组,2组患者均于围手术期接受全程护理。比较2组手术指标、术后并发症发生情况及排便功能。 结果观察组术中出血量、住院时间分别为（104.24±39.08）ml和（15.62±3.10）d,与对照组（120.46±47.35）ml和（17.20±2.95）d,差异有统计学意义（P<0.05）;观察组手术时间、造口时间、术后切口愈合时间分别为（233.12±40.50）min、（21.87±9.23）min和（7.31±0.28）d,与对照组（231.38±39.04）min、（20.95±9.14）min和（7.05±0.34）d,差异无统计学意义（P>0.05）。观察组排便功能优良率显著高于对照组,差异有统计学意义（67.50% vs 34.21%,P<0.05）。观察组造口旁疝的发生率显著低于对照组,差异有统计学意义（2.50% vs 18.42%,P<0.05）;但2组间造口出血、造口水肿、造口回缩或脱垂等发生率比较,差异无统计学意义（P>0.05）。 结论经腹-会阴联合直肠癌根治术后经腹膜外造口可显著降低术后造口旁疝的发生率,促进其排便功能的恢复,整体疗效优于经腹膜内造口。     

Combined radical prostatectomy and abdominoperineal resection for locally invasive rectal cancer

INTRODUCTION

An infiltration of urological organs is found in 5–10% of patients with colorectal carcinoma. Total pelvic exenteration is the standard procedure for locally advanced rectal cancer. In selected patients with rectal cancer involving the prostate or seminal vesicles, the bladder can be preserved and en bloc radical prostatectomy with abdominoperineal rectal resection can be performed. We report two patients who treated with this combined approach.

PRESENTATION OF CASE

Two patients with symptoms of rectal bleeding and pelvic pain were investigated. Colonoscopy demonstrated a tumor in the lower rectum. Biopsies revealed adenocarcinoma. Both pelvic MRI and endorectal ultrasound showed tumors that invaded the prostate and the seminal vesicles directly but without invasion of the bladder. After neoadjuvant chemoradiation, combined radical prostatectomy and abdominoperineal amputation was performed. None has developed local recurrence, but one of them was operated on for a single lung metastasis. After a follow-up of 28 and 20 months, respectively, the patients are alive without evidence of local recurrence or distant disease.

DISCUSSION

This procedure obviates the need for urinary diversion without compromising the local tumor control. Intraoperative and postoperative diagnostic difficulties, and clinical aspects in relation to postoperative anastomotic leak and survival of patients are discussed.

CONCLUSION

En bloc radical prostatectomy and proctosigmoidectomy is feasible in selected patients with rectal cancer and invasion limited to the prostate or seminal vesicles because it provides good local tumor control and significantly improves the patient''s quality of life in comparison to total pelvic exenteration.     

腹会阴联合切除与经肛提肌外腹会阴切除术治疗低位直肠癌的近期疗效比较

目的探讨经肛提肌外腹会阴切除术(ElAPE)治疗进展期低位直肠癌的可行性、安全性及有效性。方法回顾分析33例进展期低位直肠癌患者的临床资料,其中采用ELAPE手术18例,传统腹会阴联合切除术(APR)15例。结果两组患者年龄、性别、肿瘤分期、肿瘤位置、手术时间、术后并发症发生率比较差异无统计学意义(P0.05),ElAPE组与APR组患者术中失血.量、术后标本环周切缘阳性率及肠管穿孔率比较差异有统计学意义(P0.05)。结论进展期低位直肠癌行ELAPE手术安全可行,可减少术中出血,降低术中标本穿孔率及标本环周切缘阳性率,且未增加并发症发生率。     

低位直肠癌经肛提肌外腹会阴联合切除术与传统术式的疗效比较

目的比较腹会阴直肠癌根治术与传统腹会阴直肠癌根治术(APR)治疗低位直肠癌的并发症及短期手术效果。方法回顾性分析2012年1月至2015年9月54例行低位进展期直肠癌手术病人的临床资料,20例病人接受传统APR手术(APR组),34例接受肛提肌外腹会阴直肠癌根治术(ELAPE组)。结果与传统APR组比较,ELAPE组术中出血量较少,术中标本穿孔率及环周切缘阳性率低,差异有统计学意义(P0.05);与传统APR比较,ELAPE组术后会阴切口并发症发生率、尿潴留发生率更高,手术时间较长,差异有统计学意义(P0.05)。经过短期随访,ELAPE组1例出现复发,无死亡病例;传统APR组盆底复发1例,死亡1例。两组局部复发率及死亡率比较差异无统计学意义(P0.05)。结论 ELAPE手术虽然在一定程度上增加了会阴区相关并发症的发生率,但其明显降低了术中直肠穿孔率和术后标本环周切缘(CRM)阳性率,减少术中出血量,提高了手术根治效果,具有非常重要的临床价值。