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我院自1986年10月～1995年10月,收住低位直肠癌病人86例.其中对不愿作腹部造口术的患者,根据DUCKS分期及转移程度按治疗原则允许下,在Miles术式的基础上,采用各种术式进行保肛,如乙状结肠重建直肠瓣、肛直肠角再建、结肠半套叠、末端肠粘膜剥离后浆肌层袖状翻卷、股薄肌带蒂代替外括约肌在会阴部人工肛门成形术等,取得一定效果.但上述手术操作较为复杂,手术时间较长.笔者根据张东铭教授《肛肠外科解剖生理学》的有关论述,保留肛管齿线部括约肌与事先腹部组在前切除直肠段病灶足够末端,但仍可能保留肛管齿线,术中可待快速速冻切片对切缘段作病切达阴性,然后在前切除后的乙状结肠代替直肠段的距肛缘上作纵状3条缝合以代替重建直肠瓣,按骶曲重建直肠角.会阴组从扩开了的肛管中把拖下来的代直肠段与保留肛管作8针～12针间断内翻“U”字缝合术.并置盆底引流及冲洗管,肛管缝合(吻合口)用油纱裹肛门排气管压迫.我院在病史统计处理中对低位直肠癌患者86例中有12例选择性用此术式,随访6个月～5年,效果理想,报告如下:
In our hospital from October 1986 to October 1995, 86 patients with low rectal cancer were enrolled. Among those patients who did not want to undergo abdominal ostomy, according to DUCKS stage and degree of transfer, according to the principle of treatment, in the Miles operation On the basis of this, various procedures are used to preserve the anus, such as sigmoid reconstruction of the rectal valve, reconstruction of the anorectal angulation, colonic semi-inversion, end of the intestinal mucosal peeling, pulpy layer sleeve-like roll, gracilis muscle pedicle in place of the external sphincter. Perineal artificial anal analplasty, etc., achieved certain results. However, the above-mentioned operation is more complicated and the operation time is longer. According to Professor Zhang Dongming’s Anatomy and Physiology of Anorectal Surgery, the author kept the sphincter of the anal canal and the prior abdominal group. Anterior resection of rectal lesions is adequate enough, but anal canal line may still be preserved. Rapid frozen section may be used to perform negative excision of the margin at the incisal margin. Then the anterior excision of the sigmoid colon replaces the anal margin of the rectal segment. Longitudinal 3 sutures instead of reconstructive rectal flaps, reconstructing the rectal angle according to curling. The perineal group made the 8-piece to 12-pin interrupted inversion of the rectal segment and the retained anal canal from the expanded anal canal. "Stitching The juxtaposition of the pelvic floor drainage and irrigation tube, anal suture (anastomosis) with oil yarn wrapped anus exhaust pipe oppression. Our hospital in the history of statistical treatment of patients with low rectal cancer in 86 cases of 12 cases of selective use of this surgery The follow-up period of 6 months to 5 years is satisfactory. The report is as follows: