改良的会阴操作法在经腹会阴联合直肠癌根治术中的应用

A modified maneuvre in perineal dissection for patients of rectal carcinoma undergoing combined abdominoperineai excision

目的 比较两种会阴操作方法在经腹会阴联合直肠癌根治术（abdominoperineal resection,APR）中的应用.方法 回顾性分析2007-2009年收治的60例直肠癌患者的临床资料.60例直肠癌的肿瘤均位于直肠前壁,30例采用改良会阴操作法（改良组）实施APR手术,另30例采用传统会阴操作法（传统组）实施APR手术,比较两组手术的时间、会阴操作时的直肠（肿瘤）破裂、尿道（阴道）损伤、术后会阴并发症发生等情况.对数据进行t检验或χ2检验.结果 会阴操作时间：改良组平均为45（45±15）min,传统组平均为70（70±20）min,两组比较差异有统计学意义（t=5.48,P＜0.05）;术中直肠（肿瘤）破裂：改良组2例,传统组5例,两组差异无统计学意义（χ2=0.64,P＞0.05）;尿道（阴道）损伤：改良组无,传统组1例,两组比较差异无统计学意义（χ2=0,P＞0.05）;会阴切口感染/裂开：改良组2例,传统组9例,两组比较差异有统计学意义（χ2=4.01,P＜0.05）.结论 改良组会阴操作比传统组手术时间短,手术更安全,术后并发症少.

Objective To compare the safety and effectiveness of two methods of perineal dissection in 60 consecutive patients of rectal carcinoma undergoing combined abdominoperineal resection.Methods In this retrospective study from 2007 to 2009, 30 cases underwent Miles＇ operation using modified method of perineal dissection（ MM group） and 30 cases undergoing Miles＇ operation using classic method of perineal dissection （ CM group）. Operative time, accidental tumor （ or rectal） perforation during the procedure, iatrogenic injury to the urethra （ or vagina） and postoperative perineal complications were compared between the two groups. Results The mean perineal operative time was （45±15） min in MM group and （ 70 ± 20） min in CM group respectively （ t = 5. 48, P 〈 0. 05 ）. There were no significant differences in the rate of tumor （ or rectal） perforation and that of urethral （vaginal） injury. There were significant difference in the rate of postoperative perineal complications （χ2=4.01, P〈0.05）.Conclusions Modified method of perineal dissection is effective and safe, and this method offers a new approach for the perineal dissection during Miles＇ operation.