What is a proctectomy?

Proctectomy is a surgery to remove all or part of the rectum. It's commonly used to treat rectal cancer. The surgery can be done in several ways. 使用的方法取决于癌症离肛门有多近以及它扩散的深度.

Your large intestine is made up of your colon and rectum. It's the last part of your digestive system. The last 6 inches of your large intestine is your rectum. Stool is stored here until it passes out your anus. 你的肛门是由环状肌肉组成的，在你放松它们排便之前，它会把粪便夹在里面. Proctectomy may remove all or part of the rectum. In some cases, it may include removing the anal opening.

Why might I need a proctectomy?

The most common reason for proctectomy is rectal cancer. 在你被诊断出患有直肠癌后，你的医疗团队将尝试将其分期. The stage of your cancer is how big it is, and how deeply it has spread into and outside of the rectum. 任何阶段的直肠癌都可以用某种类型的直肠切除术来治疗.

直肠切除术也可用于治疗炎症性肠病. This includes:

• Ulcerative colitis. 这会导致溃疡和感染在结肠和直肠的内层形成.

• Crohn's disease. 这会导致炎症、刺激和溃疡深入结肠壁. It can happen anywhere along the digestive tract.

What are the risks of a proctectomy?

Every surgery has risks. The risks of this surgery include:

• Bleeding

• Pain

• 伤口部位或腹部感染

• 血凝块在腿部静脉中形成，然后转移到肺部(肺栓塞)

• Leaking inside your body at the joined tissues and vessels

• Trouble passing urine

• Trouble having bowel movements

• Wound healing problems or opening of the wound

• Scar tissue (adhesions)

• Sexual problems

• Heart or brain injury from anesthesia

• Inability to control bowel movements (incontinence)

There may be other risks, depending on your health. 如果您有疑虑，请在手术前咨询您的医疗保健提供者.

How do I get ready for a proctectomy?

在进行直肠切除术之前，您的医疗团队将对您进行全面的评估. 这样做是为了了解你的整体健康状况，分期癌症，并计划你的手术. 它可能包括影像学检查、血液检查和心电图检查你的心脏. 结肠镜检查将检查你的结肠和直肠内部，如果还没有做过的话.

Here's what to expect before surgery:

• Your bowels must be empty and cleaned out for the surgery. 你需要在手术前改变你的饮食摄入量. Follow all of your healthcare team’s directions.

• You may need to do bowel prep. This may include a laxative and enemas to clean out your bowel.

• You may need to take antibiotics before surgery. This is to help reduce your risk for infection. 有时抗生素是通过静脉注射给你的. 这是在手术前做的，也可以在手术中做.

• You may be asked to stop smoking about 2 weeks before surgery. Smoking delays healing and recovery. Ask your healthcare provider if you need help stopping.

• 告诉你的医疗团队你服用的所有药物、维生素、草药和补品. 这包括非处方药，以及非法药物和大麻. 你可能需要在手术前一周停止服用一些药物. This includes any medicines that thin the blood.

Your healthcare provider may give you other directions.

What happens during a proctectomy?

You'll be given general anesthesia for the surgery. 这是一种药，可以让你入睡，在手术过程中不会感到疼痛.

Here are the different types of surgery that can be done:

• Minimally invasive laparoscopic surgery. 对于这种方法，外科医生会在你的腹部开几个小切口. 一根末端带有微型摄像头的管子可以在视频屏幕上看到你的身体内部. 特殊的长而细的工具被放入切口，用来做手术. Laparoscopic surgery can also be robot-assisted. 这是指外科医生使用电脑控制机械臂来进行手术.

• Local resection or transanal excision. 如果癌症可以通过肛门到达并且没有扩散得太深，这些方法是可以选择的. The surgery is done through the anal opening. An incision in the belly isn't needed.

• Low anterior resection (LAR). 在直肠较高和较深的癌症可能需要开放的LAR, which is a different type of surgery. 直肠的大部分将通过在下腹部做一个切口切除. 这种方法可以让外科医生寻找癌症在腹部扩散的迹象.

• Anastomosis. 如果有足够的健康直肠组织，末端会通过这种手术重新连接. 它能让你通过肛门正常排便. But the pattern of your bowel movements will likely change. This includes how often you go, and how solid your stools are.

• Abdominoperineal resection (APR). 如果直肠癌较大且靠近肛门开口，则可以这样做. For APR, the rectum is removed and the anal opening is closed. 结肠的另一端连接在你下腹的一个开口(称为造口)上. This is called a colostomy. 然后将肠道运动收集在覆盖结肠造口的袋子中.

• Pelvic exenteration. This surgery may be needed in rare cases. 为此，切除附近的器官，如膀胱、前列腺或子宫. A colostomy is always needed after this surgery.

Even if you don't have a permanent colostomy after proctectomy, a short-term ileostomy might be needed. 这是当你的小肠的最后一部分连接到你腹部的一个洞(称为气孔)时。. 粪便从口排出，而不是通过结肠和直肠. This allows your rectum to heal. 如果你在手术后需要更多的治疗，比如放射治疗，也可以这样做. 之后，再做一次手术来重新连接肠道并关闭回肠造口.

你的外科医生会和你谈谈要做的手术. 确保你知道手术后会发生什么，以及你的身体会是什么样子.

What happens after a proctectomy?

手术后你需要在医院住几天. You will have a tube (catheter) in your bladder to drain urine. You may also have surgical drains. These are used to keep fluid from collecting in the treated area. 医生会给你止痛药、抗生素和血液稀释剂，以防止血栓形成. 你可能有几天不能吃东西，以便给你的直肠时间愈合. You'll be taught how to manage your colostomy or ileostomy.

Before you go home, the tubes and drains are often removed. Your pain should be controlled, and you should be able to eat and drink, but you may have special directions. You will be able to walk and take basic care of yourself. But have someone stay with you for a week or so.

When you go home, follow all the directions for medicines, pain control, diet, activity, bathing, and wound care.

If you have a colostomy or ileostomy, 你可能需要与造口护士或肠造口治疗师一起工作. Make sure to keep all your follow-up appointments. This specialist will show you how to use the ostomy pouch, deal with possible side effects, such as skin irritation, and get back to an active life. 通过正确的护理，袋子不会在你的衣服下面被看到. People won’t even know you are wearing it.

Some other common instructions after proctectomy may include:

• Get up and walk as much as possible soon after surgery. This is to help you breathe better and prevent blood clots.

• Slowly get back to your normal activities. This may take a few months. 询问你的医生你什么时候可以恢复洗澡、开车、工作和性生活. Don’t do heavy lifting for at least 6 weeks.

• Watch your wounds for any sign of infection. 这可能包括肿胀、发红、疼痛、出血或液体泄漏.

确保你知道什么问题需要注意，什么时候需要打电话给你的医疗保健提供者. 还要确保你知道在工作时间以外、周末和节假日可以拨打什么电话寻求帮助.

你是否已经预约了后续工作，并知道下一步要做什么.

When to call your healthcare provider

Call your healthcare provider if you have any of the below:

• Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

• Swelling, redness, bleeding, or fluid leaking from the incision

• Pain that gets worse

• Shortness of breath