Long-term outcomes of a neo-anus with a pudendal nerve anastomosis contemporaneously reconstructed with an abdominoperineal excision of the rectum
Long-term outcomes of a neo-anus with a pudendal nerve anastomosis contemporaneously reconstructed with an abdominoperineal excision of the rectum
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DOI：
10.1016/j.surg.2004.05.046
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发表时间：
2005-01-01
期刊：
影响因子：
3.8
通讯作者：
Nagai, H
中科院分区：
文献类型：
--
作者：
Sato, T;Konishi, F;Nagai, H
背景在动物研究中，阴部神经支配可以将新括约肌转变为原始的肛门括约肌样肌肉。结果导致我们进行了阴部神经吻合术（NAPNA）的新肛门临床试验。没有长期的结果，在一系列已被证实。从1995年至2003年，19例（17例男性，2例女性;中位年龄，62.0岁;范围，46-73岁）低位恶性肿瘤患者通过使用臀大肌下部与阴部神经吻合术同时进行直肠腹会阴切除术（APER）来重建新肛门。对远期（< 2年）临床疗效进行评价。术后6.6 +/- 1.8个月时，新括约肌开始收缩（n = 15）;然后在9.1 +/- 2.6个月时关闭回肠造口（n = 14）。在10例患者中研究了长期结果（回肠造口闭合后40.9 +/- 14.1个月）。所有患者（100%）排便次数为4.8 +/- 2.6次/天，无冲洗。9例患者（90%）每天使用衬垫。克利夫兰诊所佛罗里达失禁评分为12.2 +/- 3.3分。没有病人失去工作。8名患者（80%）回答说，他们的生活与NAPNA比回肠造口术。NAPNAs患者的平均世界卫生组织生活质量-BREF显著优于在我院接受常规APER的患者（n = 27，66.4 +/- 0.8岁）（P 0.0402）。4例患者（40%）需要排便，获得了显著更好的排便评分（平均值+/- SD）。敏感地认识到排便的必要性可能是国家适应行动方案取得成功的关键。对于希望避免APER后造口的选定患者，NAPNA可以是一种实用的选择。
Background. Pudendal nerve innervation can transform a neo-sphincter into an original anal sphincter-like muscle in animal studies. The results led us to clinical trials of a neo-anus with a pudendal nerve anastomosis (NAPNA). No long-term results in a series have been reported.Methods. From 1995 to 2003, a neo-anus was reconstructed by using an inferior portion of the gluteus maximum muscle with a pudendal nerve anastomosis contemporaneously with an abdominoperineal excision of the rectum (APER) in 19 patients (17 men, 2 women; median age, 62.0 years; range, 46-73) with low-lying malignancy. The long-term (< 2 years) clinical results were evaluated.Results. The neo-sphincter began contracting (n = 15) at 6.6 +/- 1.8 months after surgery; then the ileostomy was closed (n = 14) at 9.1 +/- 2.6 months. The long-term results were studied in 10 patients (40.9 +/- 14.1 months after ileostomy closure). All patients (100 %) defecated at 4.8 +/- 2.6 times/day without irrigation. Pads were used every day in 9 patients (90 %). The Cleveland Clinic Florida incontinence score was 12.2 +/- 3.3 points. No patients lost their occupation. Eight patients (80 %) answered that their life with a NAPNA was better than with an ileostomy. The average World Health Organization Quality of Life-BREF in patients with NAPNAs was significantly better than that in those patients who underwent conventional APERs in our hospital (n = 27, 66.4 +/- 0.8 years old) (P .0402). Four patients (40 %) experiencing the need to defecate got significantly better continence score (mean +/- SD).Conclusions. The sensitivity to recognize the need to defecate may be a key to success in NAPNAs. A NAPNA can be a practical option for selected Patients wishing to avoid a stoma after an APER.