Classification of Damages of Holding Structures of Anorectum in Rectal Cancer Surgery
The detailed study of difficult anatomic mutual relations of muscles of diaphragm of pelvis after the surgical operation is extraordinarily important for the choice of adequate surgical technique, as well as development of the new methods of surgical reconstruction of holding structures of anorectum for the improvement of quality of life after the operation.
Aim of the work — to create effective classification of damages of holding structures of anorectum after surgical operations for cancer of the rectum on the basis of MRI of pelvic diaphragm.
Material and methods. In 37 patients with the cancer of rectum after performing of surgical operations, the MRI of zone of small pelvis has been carried out using MR-tomography Siemens magnitol concerto, with tension of magnetic-field 0.1 TL. Main types of damage of pelvic diaphragm are covered. For the study of functional results in investigated group of patients, anal function has been measured by using device of Sphyncterometr, invented in institute of coloproctology of the Russian Federation. The obtained results were compared to the values of indexes of healthy persons, got in previous researches.
Studies were carried out in a year after an operation because to this term the bowel most effectively adapts itself to the new conditions of digestion.
Results. First degree of damage. List of variants, that we attributed to the first degree of damage of holding structures of anorectum consists in a proctectomy and by the violations related to the loss of reservoir function of ampoule of the rectum, crossing of anococcygeal ligament, the lowering down of the colon to perineum with excision of actually-muscular layer of rectum and overstretch of holding structures, because of locating in the anal channel of lowered down colon with a mesentery. Second degree of damage. Include the partial crossing of internal sphincter, partial crossing of fibres of puborectalis muscle and levator plate. Third degree of damage. Characterized by the complete removal of all muscular elements of internal sphincter, crossing of deep portion of external sphincter and crossing of puborectalis muscle. On such protocol ISR is executed concerning to the tumors with localization in a lower third of the rectum. Fourth degree of damage. In this group of damages of pelvic diaphragm take damages after operations concerning the cancer of lower third of the rectum and anal channel. Demucosation of anal channel with maintenance only of subcutaneous portion of external sphincter requires from the surgeon of crossing of practically all muscular elements of pelvic diaphragm. This type of damage is most traumatic.
In a year after the executed operative intervention for patients with the first degree of damage the indexes of sphincter measurement substantially did not differ from such in the group of healthy persons. In patients with the second degree of damage the partial character of crossing of internal sphincter and levators absence of total damage of muscular elements providing the anal holding do this type of operative intervention is functionally-effective providing satisfactory quality of life. The third degree of damage is characterized by a considerable decline of the indexes so tone as muscular constriction. A fourth degree is characterized practically by total destruction of holding structures. The functional results of this interventions and degree of social adaptation of patients are comparable with the perineal colostomy.
Conclusions. Classification of damages of holding structures of anorectum on the basis of MRI after one or another type of operation due to cancer of rectum will allow to work out the complex of restoration-plastic methods in every case taking into account individual features, localization of tumor and functional conditions of muscles of pelvic diaphragm.
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