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世界核心医学期刊文摘（胃肠病学分册） 2005年第9期1卷 25-25页

作者： marchal F. Doucet C. Lechaux D. P.-A.Lehur 杨雪娟 Clinique Chirurgicale II Ple Digestif Htel Dieu Place Alexis Ricordeau 44093 Nantes France

Introduction-Fecal continence with a perineal colostomy performed after abdominoperineal resection (APR) is not always satisfactory despite retrograde colonic enemas. Functional improvement is currently examined using artificial sphincters. Preliminary results are disclosed. Patients-In 3 female patients, 45, 59 and 68 years old, curative APR and perineal colostomy were performed after radiotherapy in 2, for t1-2N0 cancer of the lower rectum. Due to occasional leaks, need for strict diet and fear of incontinence,an Acticon Neosphincter(r) (AMS)was implanted consecutively at a mean 4.5 years after APR. Results-Device implantation was feasible and uneventful. In one case, a superficial hematoma was drained and healed by second intention. Devices were activated 3 months after implantation. At a mean 2.5 years follow-up, the 3 patients had an activated and functional artificial sphincter. Leaks and fecal urgency significantly decreased but colonic enemas were maintained. Dietary restrictions were less and quality of life improved. All 3 considered the device as a useful adjunct. Conclusion-In this limited experience, implantation of artificial sphincter around a perineal colostomy following APR for rectal cancer appeared feasible and safe even in case or previous radiotherapy. Midterm tolerance was satisfactory. Continence and quality of life significantly improved.

关键词：腹会阴切除肠癌患者结肠造瘘结肠造口生活质量大便失禁放射治疗活性功能饮食限制二次处理

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