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目前,直肠癌在行Miles手术时多采用左侧结肠的肠造口术,由于结肠造口术有多种早期和晚期的术后并发症,给直肠癌患者的愈后带来精神上和肉体上及今后生活中造成很大负担。因此,Miles手术不易被病人所接受,因而我们采用腹壁游离皮瓣,分开肌肉,切开腹膜,将造口部肠管从此皮瓣下拖出,用游离的皮瓣顺时针旋转,缝合。最后筑造成高3～4cm,呈“柱状”的永久性皮管造口。它不仅避免了早、晚期并发症的发生,而且由于排气、排便冲撞皮管,使皮管扩张,刺激皮管的皮肤感受器,使病人有明显的排便知觉,以利排便的护理。皮管不怕摩擦,耐受各种劳动。造型美观,能够提高病人的生活质量。便于安放各种人工肛门装具及肛门塞,补充了Miles手术的不足。
Currently, colorectal cancer often uses colon colostomy in the left side of the colon. There are many early and late postoperative complications of colostomy, which brings mental and physical benefits to patients with rectal cancer. There is a great burden on our lives and in the future. Therefore, Miles surgery is not easily accepted by patients, so we use the abdominal wall free flap, separate the muscles, cut the peritoneum, pull the stoma intestine from under this flap, rotate it clockwise with a free flap, and sew. Finally, a permanent 3⁄4 cm high, stylus-like permanent stoma was created. It not only avoids the occurrence of early and late complications, but also exhausts and defecates against the skin, causing the skin tube to expand, stimulating the skin’s skin receptors, so that the patient has a clear sense of defecation in order to facilitate defecation care. The leather tube is not afraid of friction and is resistant to various kinds of labor. Beautiful appearance can improve the patient’s quality of life. It is convenient to place various artificial anal harnesses and anal plugs, supplementing the shortcomings of Miles surgery.