Coloanal anastomosis in the management of benign and malignant rectal disease.
Coloanal anastomosis in the management of benign and malignant rectal disease.
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结肠吻合术治疗良性和恶性直肠疾病。
DOI：
10.1097/00000658-198711000-00008
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发表时间：
1987
影响因子：
9
通讯作者：
B. Wolff
中科院分区：
文献类型：
--
作者：
D. Drake;J. Pembérton;R. Beart;R. Dozois;B. Wolff
目的是确定结肠肛管吻合术治疗复杂良性和恶性直肠疾病的有效性、安全性以及长期临床和功能结果。 29 名患者接受了结肠或结肠肛管吻合术，原因是直肠癌在技术上不适合传统的低位前切除术、严重的放射损伤、大型良性下三分之一肿瘤或先前手术的并发症。患者的平均年龄为 61 岁，其中 82% 为男性。 55% 的患者进行了改道结肠造口术。平均 (+/- SEM) 随访时间为 20 +/- 3 个月。无手术死亡。然而，40% 的患者出现短暂性尿潴留，28% 的患者出现吻合口狭窄，3.4% 的患者出现吻合口漏。四名患者（14%）无法恢复肠道连续性，因此被认为是失败。所有剩余患者 (N = 25) 的大便频率为每天 3 +/- 1 次（平均值 +/- SEM），并且不随年龄、性别或手术指征而变化。 84% 的患者实现了完全节制，但没有患者因肠道功能不良而丧失能力。对于传统结肠直肠造口术不切实际或不明智的患者，结肠肛门吻合术是一种安全有效的替代手术，可以保持肛门失禁。
The aim was to determine the efficacy, safety, and long-term clinical and functional results of coloanal anastomosis in patients with complicated benign and malignant rectal disease. Twenty-nine patients underwent coloanal or colopouch-anal anastomosis for either carcinoma of the rectum not technically amenable to conventional low anterior resection, severe radiation injury, large benign lower third tumors, or complications of previous operations. The mean age of the patients was 61 years and 82% were men. A diverting colostomy was constructed in 55% of the patients. The mean (+/- SEM) length of follow-up was 20 +/- 3 months. There was no operative mortality. Transient urinary retention, however, occurred in 40%, anastomotic stricture in 28%, and anastomotic leakage in 3.4%. Four patients (14%) could not have intestinal continuity restored and therefore were considered failures. The stool frequency for all remaining patients (N = 25) was 3 +/- 1 per day (mean +/- SEM) and did not vary with age, sex, or indication for operation. Complete continence was achieved by 84% of patients, but no patient was incapacitated by poor bowel function. In patients in whom a conventional colorectostomy is impractical or unwise, coloanal anastomosis is a safe and efficacious alternative operation that preserves anal continence.