尿生殖膈直接贯通法在腹会阴联合直肠癌根治术中的应用

Direct dissection of urogenital diaphragm in abdominoperineal resection

目的比较两种会阴手术方法在腹会阴联合直肠癌根治术中的应用。方法2007年6月至2011年6月河南省肿瘤医院普外科126例进行腹会阴联合手术的男性直肠癌患者，采用随机表法随机分为尿生殖膈直接贯通手术组和传统手术组两组，对照比较两组会阴手术操作时间、直肠和肿瘤破裂、尿道损伤、术后会阴出血发生率等指标。结果尿生殖膈直接贯通法手术组会阴手术操作时间短于传统手术组[（16±5）rain比（23±5）min，P=0．032）]，而在直肠或肿瘤破裂、尿道损伤及术后会阴出血发生方面与传统手术组差异无统计学意义（1例比5例，2例比5例，0例比1例，1例比3例，均P〉0．05）。结论腹会阴联合直肠癌根治术中会阴组采用尿生殖膈直接贯通法在男性直肠癌患者中较传统手术方法更具操作优势。

Objective To compare the clinical outcomes of two operative approaches of perineal dissection in rectal carcinoma undergoing abdominoperineal resection. Methods A randomized controlled trial was conducted in a total of 126 patients with rectal cancer undergoing the Miles operation from June 2007 to June 2011 at Henan Provincial Cancer Hospital. They were divided into 2 groups. One group （Group A） underwent a direct dissection of urogential diaphragm while another group （Group B） received the traditional operative method. And the duration of perineal surgery, rupture of rectum or tumor, urethral injury and the post-operative rate of perineal hemorrhage were compared between 2 groups. Results Group A had a shorter duration of perineal surgery （ （ 16 -＋ 5 ） min vs （23 -＋ 5 ） min, P = 0. 032）. And the differences were significant statistically. However the rupture of rectum or tumor, urethral injury and the post-operative rate of perineal hemorrhage were equivalent for two groups （ 1 vs 5, 2 vs 5, 0 vs I, 1 vs 3, all P 〉 0.05 ）. Conclusion A direct dissection of urogential diaphragm offers more clinical advantages over the traditional operative method in abdominoperineal resection.