直肠癌柱状腹会阴切除术腹腔预留牵引经会阴关闭腹膜重建盆底的临床疗效观察

Preliminary result of reconstruction of pelvic floor with peritoneum following cylindrical abdominoperineal resection

目的 探讨直肠癌柱状经腹会阴切除术（abdominoperineal resection,APR）腹腔预留牵引经会阴盆底腹膜直接关闭重建盆底的临床效果.方法 回顾性分析我科27例低位直肠癌行柱状APR手术的患者盆底重建的临床疗效,观察患者会阴手术切口愈合、引流管留置时间、盆底疝等相关术后并发症.结果 27例患者中切口感染合并裂开2例,切口延迟愈合6例,盆底小肠疝1例,输尿管梗阻1例,引流管拔除时间平均（13.9±4.6）d.术后6个月复查MRI与术前相比较,盆底有所下降.结论 直肠癌柱状APR术后经会阴直接关闭盆底腹膜是重建盆底的有效方法,对临床有一定的指导意义,但是远期疗效有待进一步随访观察.

Objective To report the preliminary result of reconstruction of pelvic floor with perito-neum following cylindrical abdominoperineal resection （APR）. Methods Cylindrical APR was performed in 27 consecutive patients with advanced very low rectal cancer between June 2009 and July 2011. The pelvic defects were reconstructed with peritoneum. Complication were observed including infection of incision,peri- neal hernia,drainage, etc. Results Perineal wounds were healed in 19 of 27 patients. Perineal wound infec- tion and rupture occurred in 2 patients,delayed union occurred in 6,perineal hernia occurred in 1, and ure-teral obstruction occurred in 1. Drainage tube was replaced after （ 13.9 ± 4.6） days. After 6 months＇follow-up, MRI showed pelvic floor was descended especially in male patients. Conclusion To suture the peritone- um directly is one method of pelvic reconstruction. It could reduce time of operation and make the procedure safer ,but its long-term effect remains to be observed.