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目的:探索直肠并阴道后壁切除(或后盆腔清除术)后,即时修复阴道后壁,又能避免腹壁人工肛门的安全合理的手术方式。方法:直肠并阴道后壁(必要时连同子宫及附件)切除后,用带血管蒂回肠片修复阴道后壁,并作结肠肛管吻合术。结果:本组5例(其中直肠癌4例,直肠阴道平滑肌肉瘤1例),无任何术后并发症。随访19~41个月,至今均健在。术后2~6个月恢复肛门自制,术后3~12个月恢复正常的性生活。结论:带血管蒂回肠片能有效修复阴道后壁缺损,使结肠肛管吻合术成为可能,与传统的只作切除不作修复的后盆腔清除术相比有显著的优越性,是一种安全并值得推荐的术式。
OBJECTIVE: To explore the safe and rational surgical approach to repair the posterior vaginal wall immediately after resection of the rectum and posterior wall of the vagina (or posterior pelvic debridement) and to avoid the artificial anus of the abdominal wall. Methods: Rectal and posterior vaginal wall (when necessary together with the uterus and accessories) after removal, with vascular pedicles repair the posterior vaginal wall, and for colon anal anastomosis. Results: There were 5 cases in this group (including 4 cases of rectal cancer and 1 case of rectovaginal leiomyosarcoma) without any postoperative complications. Follow-up 19 to 41 months, have been alive so far. The anus was restored 2 to 6 months after surgery, and normal sexual activity was restored 3 to 12 months after surgery. Conclusion: Vascularized ileal patch can effectively repair the defect of posterior vaginal wall and make colonic anal canal anastomosis possible. Compared with conventional pelvic evacuation without reparation only, it is a safe and superior method. Recommended surgical technique.