不能保肛的直肠癌手术治疗进展及评价

Advances in the surgical treatment of rectal cancer in patients not suitable for sphincter-preserving operation

大规模的临床研究显示,传统直肠癌腹会阴联合切除术[abdominoperineal excision,APE;或称为abdominalperineal resection(APR)]环周切缘(circumferencial resection margin,CRM)阳性率较高和手术中穿孔率较高是其术后局部复发率高和病人存活率低的重要原因。因此,其作为不能保留肛门的低位直肠癌的手术治疗金标准逐渐受到挑战。直肠癌柱状腹会阴联合切除(cylindrical abdominoperineal excision,CAPE)即直肠癌肛提肌外腹会阴联合切除(extral levator abdominoperineal excision,ELAPE)手术能够显著降低直肠癌手术后环周切缘阳性率及局部复发率,且不增加手术打击,使其可能成为传统APE以外的一个新选择。应进一步验证该手术的长期疗效和病人生活质量,同时应制订手术规范,更好地保护植物神经和采用个体化的手术方案。

Large-scaled clinical studies showed that high CRM positive rate and intraoperative bowel perforation were important factors causing high local recurrence and lower survival rate in low rectum cancer. So its has been challenged as the golden standard of procedure for rectum cancer. Cylindrical APE/extralevator APE can significantly reduce CRM positive rate and local recurrence rate. Furthermore, with no increasing operative trauma, it becomes a new alternative to traditional APE. This paper also suggests that further research should be carried out to verify the long-term benefit and life quality of this procedure. On the other hand, more attention should be paid to build up the operative guidelines, improvenerve preservation and make individualized operation plan.