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目的观察原位肛门重建术式的控便能力及其在低位直肠癌患者中的临床应用效果。方法对48只家猫采用4种不同的术式行原位肛门重建,即A,B、C三组切除肛门内外括约肌,其中A组游离股薄肌包裹;B组结肠套叠;C组结肠套叠加股薄肌包裹;D组结肠套叠保留肛门外括约肌。术前、术后1、3、6个月测量重建肛管及直肠内压。临床资料分为重建组和Miles组,每组60例,重建组的术式按动物实验C组方法原位肛门重建者48例,按D组手术方法原位肛门重建者12例。术后6个月以后评价控便效果,并分析重建组和Miles组的术后1、3、5年生存率。结果术后4组肛管内压及直肠内压均低于术前组(P<0.05);术后C、D组肛管内压及直肠内压高于术后A组(P<0.05);而A、B组之间以及C、D组之间差别无统计学意义(P>0.05)。应用C、D组术式治疗的60例直肠癌患者,术后控便功能优良者为78.33%(47/60);重建组术后1、3、5年生存率为:100.00%、68.33%、48.33%,Miles组术后1、3、5年生存率为98.33%、71.67%、45.00%。重建组和Miles组术后1、3、5年生存率差异无统计学意义(P>0.05)。结论原位肛门重建术既可根治肿瘤,同时能重建患者的排便功能。
Objective To observe the ability of defecation in situ anal reconstruction and its clinical application in patients with low rectal cancer. Methods Forty-eight domestic cats were treated with four different surgical procedures for primary anus reconstruction: group A, B and C were performed excision of anus internal and external sphincters, in which group A was covered with free gracilis; group B colon and intussusception; group C colon Set superimposed thin gracilis wrapped; D group intussusception retention of the external anal sphincter. Preoperative and postoperative 1,3,6 months to reconstruct the anal canal and rectal pressure. The clinical data were divided into reconstructive group and Miles group, 60 cases in each group. According to the method of animal experiment group C, 48 cases were reconstructed in situ by reconstruction group and 12 cases were reconstructed in situ by group D method. Control efficacy was evaluated 6 months after surgery and 1, 3, 5 year survival rates were analyzed in the reconstructed and the Miles groups. Results The anal canal internal pressure and rectum pressure were lower in the 4 groups after operation than those in the preoperative group (P <0.05). Anal canal internal pressure and intra-rectal pressure were significantly higher in group C and group D than those in group A (P <0.05) There was no significant difference between groups A and B and groups C and D (P> 0.05). Sixty patients with rectal cancer who underwent operation C and D were 78.33% (47/60) with excellent postoperative bowel control. The 1, 3, 5 year survival rates were 100.00% and 68.33% , 48.33%. The 1-, 3-, 5-year survival rates of Miles group were 98.33%, 71.67% and 45.00% respectively. There was no significant difference in the 1, 3, 5-year survival rates between the reconstruction group and the Miles group (P> 0.05). Conclusions Orthotopic anal reconstruction can both cure the tumor and reconstruct the defecation function of the patients.