磁压榨技术治疗直肠狭窄1 例并文献回顾

Background and Aims: Anastomotic stenosis after rectal cancer surgery is a frequently encountered problem in clinical practice. Endoscopic balloon dilatation is a common minimally invasive treatment. However, endoscopic treatment is difficult to perform for the anastomotic site with severe stricture or even occlusion. This paper is to introduce the diagnosis and treatment experience of a case of severe rectal stenosis and a longer stenotic segment after rectal cancer surgery which was cured successfully by a self-designed and developed magnetic ring under endoscopic-assistance according to the principle of magnetic compression technique (MCT), so as to provide a new perspective and approach for the minimally invasive treatment of rectal stenosis. Methods: The clinical data of a patient with rectal stenosis after rectal cancer surgery treated in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively analyzed. The patient was a 66-year-old male who was scheduled to undergo ileostomy reduction 6 months after radical resection for rectal cancer. In the patient, lower rectal stenosis was observed during colonography, and the implementation of endoscopic balloon dilatation failed in the local hospital. Then, the patient came to our hospital for MCT stenosis recanalization. At the same time, the literature about MCT in the treatment of rectal stenosis or atresia was extracted and analyzed. Results: NdFeB magnetic rings with titanium nitride coating surface were used in the patient. During the operation, the magnetic rings were inserted into both ends of the stenosis segment through the ileostomy and anus respectively with the aid of an endoscope. The magnet rings were difficult to attract each other effectively because of the long stenotic segment. Then the operative approach was changed. The zebra guide wire was inserted through the ileostomy under endoscopic guidance and the guide wire passed through the stenotic segment of the rectum and was led out of the body through the anus. The assembled magnetic rings were inserted into both ends of the rectal stenosis through the ileostomy and anus along the zebra guide wire. The magnets were attracted to each other in the right position. As time went on, the distance between the magnets increasingly shortened, and the magnetic rings were discharged spontaneously through the anus 6 d after the operation. Immediate colonoscopy was performed which showed the recanalization of rectal anastomosis, and catheter support was given. The patient returned to the local hospital and successfully underwent ileostomy reduction as planned. Followup was conducted for 5 months until manuscript preparation, and the patient exhibited normal defecation. The literature search found that there were 4 cases of rectal stenosis/atresia treated by MCT at home and abroad. Although the operative approach and magnetic rings used in these cases were different, satisfactory treatment results were finally achieved in all of them. Conclusion: Patients with rectal stenosis have different causes, and there are great differences in the degree and length of stenosis. When using MCT as a treatment method, individual differences in the condition of patients should be fully considered, and the selection of the most appropriate operative approach and magnetic rings is the premise of obtaining favorable treatment results. As a new type of anastomosis, MCT combined with endoscopy in the treatment of rectal stenosis has the advantages of simple operation, less trauma, and demonstrable efficacy.