| Project/Area Number |
15591434
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Digestive surgery
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| Research Institution | JICHI MEDICAL SCHOOL |
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Principal Investigator |
OKADA Masaki Jichi Medical School, School of Medicine, Associate Professor, 医学部, 助教授 (40254924)
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| Co-Investigator(Kenkyū-buntansha) |
HORIE Hisanaga Jichi Medical School, Lecturer, 医学部, 講師 (20316532)
ENDO Noriyuki Jichi Medical School, Assistant, 医学部, 助手 (30296090)
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| Project Period (FY) |
2003 – 2005
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| Project Status |
Completed (Fiscal Year 2005)
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| Budget Amount *help |
¥3,600,000 (Direct Cost: ¥3,600,000)
Fiscal Year 2005: ¥700,000 (Direct Cost: ¥700,000)
Fiscal Year 2004: ¥700,000 (Direct Cost: ¥700,000)
Fiscal Year 2003: ¥2,200,000 (Direct Cost: ¥2,200,000)
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| Keywords | neoanus / sphincter / rectal cancer / reconstruction / QOL / 肛門機能再建 / 人工肛門 / アヌス |
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| Research Abstract |
BACKGROUND : Pudendal nerve innervation can transform a neo-sphincter into an original anal sphincter-like muscle in animal studies. The results led us to clinical trials of a neo-anus with a pudendal nerve anastomosis (NAPNA). No long-term results in a series have been reported. METHODS : From 1995 to 2003, a neo-anus was reconstructed by using an inferior portion of the gluteus maximum muscle with a pudendal nerve anastomosis contemporaneously with an abdominoperineal excision of the rectum (APER) in 19 patients (17 men, 2 women ; median age, 62.0 years; range, 46-73) with low-lying malignancy. The long-term (<2 years) clinical results were evaluated. RESULTS : The neo-sphincter began contracting (n=15) at 6.6 +/-1.8 months after surgery ; then the ileostomy was closed (n=14) at 9.1 +/-2.6 months. The long-term results were studied in 10 patients (40.9 +/-14.1 months after ileostomy closure). All patients (100%) defecated at 4.8 +/-2.6 times/day without irrigation. Pads were used every day in 9 patients (90%). The Cleveland Clinic Florida incontinence score was 12.2 +/-3.3 points. No patients lost their occupation. Eight patients (80%) answered that their life with a NAPNA was better than with an ileostomy. The average World Health Organization Quality of Life-BREF in patients with NAPNAs was significantly better than that in those patients who underwent conventional APERs in our hospital (n=27, 66.4 +/- 0.8 years old) (P=.0402). Four patients (40%) experiencing the need to defecate got significantly better continence score (mean +/-SD). CONCLUSIONS : The sensitivity to recognize the need to defecate may be a key to success in NAPNAs. A NAPNA can be a practical option for selected patients wishing to avoid a stoma after an APER.
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