RESUMO
BACKGROUND: Our aim was to evaluate complications and long-term functional outcome in patients who had sphincter reconstruction using the gluteus maximus muscle as the neosphincter after abdominoperineal resection for rectal cancer treatment. METHODS: Seven patients underwent reconstruction from 2000 to 2010. First, the sigmoid colon was brought down to the perineum as a perineal colostomy, with the procedure protected by a loop ileostomy. Reconstruction of the sphincter mechanism using the gluteus maximus took place 3 months later, and after another 8-12 weeks, the loop ileostomy was closed. We studied the functional outcome of these interventions with follow-up interviews of patients and objectively assessed anorectal function using manometry and the Cleveland Clinic Florida (Jorge-Wexner) fecal incontinence score. RESULTS: The mean follow-up was 56 months (median 47; range 10-123 months). One patient had a perianal wound infection and another had fibrotic stricture in the colocutaneous anastomosis that required several digital dilatations. Anorectal manometry at 3-month follow-up showed resting pressures from 10 to 18 mm Hg and voluntary contraction pressures from 68 to 187 mm Hg. Four patients had excellent sphincter function (Jorge-Wexner scores ≤5). CONCLUSIONS: Our preliminary results show that sphincter reconstruction by means of gluteus maximus transposition can be effective in restoring gastrointestinal continuity and recovering fecal continence in patients who have undergone APR with permanent colostomy for rectal cancer. Furthermore, the reconstruction procedure can be performed 2-4 years after the APR.
Assuntos
Canal Anal/cirurgia , Músculo Esquelético/transplante , Procedimentos de Cirurgia Plástica/métodos , Qualidade de Vida , Neoplasias Retais/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Idoso , Canal Anal/patologia , Nádegas/cirurgia , Estudos de Coortes , Colostomia/métodos , Incontinência Fecal/prevenção & controle , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Laparotomia/métodos , Masculino , Manometria , Pessoa de Meia-Idade , Períneo/cirurgia , Cuidados Pós-Operatórios/métodos , Neoplasias Retais/patologia , Reoperação/métodos , Estudos Retrospectivos , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
La pancreatitis aguda es la inflamación aguda del páncreas con grado variable de compromiso de los tejidos regionales y diferente grado de compromiso sistémico. Se utilizan como definiciones las establecidas en el consenso de Atlanta (anexo 1). B. Diagnóstico 1. Historia clínica. Se presenta dolor en hemiabdomen superior, usualmente serio y acompañado de grados variables de vómito, náuseas y fiebre. Son importantes los antecedentes personales y familiares. 2. En el examen físico siempre se deben incluir el peso, la talla, el índice de masa corporal (IMC), la temperatura, la saturación de oxígeno (SAO2), la frecuencia cardiaca, la frecuencia respiratoria y la tensión arterial.