腹腔镜下肛提肌外腹会阴联合切除术与传统Miles手术近期疗效的对比研究

Comparison of short-term outcomes between laparoscopic extralevator abdominoperineal excision and lap- aroscopic Miles operation

目的分析腹腔镜下肛提肌外腹会阴联合切除术（ELAPE）与腹腔镜下传统Miles手术治疗低位直肠癌近期疗效的异同以及腹腔镜下ELAPE手术的可行性。方法回顾性分析2012年1月至2013年12月间37例腹腔镜腹会阴联合切除术治疗的低位直肠癌病例，其中腹腔镜下ELAPE手术者21例（L_ELAPE组），腹腔镜下传统Miles手术16例（L-Miles组）。比较两组患者一般资料、手术时间、术中出血量、术后会阴部切口局部并发症、术后住院时间。结果L-ELAPE组21例，L-Miles组16例，两组一般资料差异无统计学意义（P〉0．05）。L-ELAPE组手术总时间为（294±53）min，术中出血量为（162±72）ml，会阴部切口局部并发症发生率为28．6％，术后住院天数为（18．9±6．6）d。L-Miles组手术总时间为（239±58）rain，术中出血量为（144±89）ml，会阴切口并发症发生率为25％，术后住院日为（20．5±5．2）d。L-ELAPE组总手术花费时间较L-Miles组长（P〈0．05），而两组患者术中出血量、术后会阴部切口局部并发症及术后住院天数差异均无统计学意义（P〉0．05）。结论腹腔镜ELAPE手术安全可行，手术时间较腹腔镜传统Miles手术有所延长。

Objective To explore the differences of short-term outcomes between laparoscopic extralevator abdominoperineal excision （L-ELAPE） and taparoscopic Miles （L-Miles） and the feasibili- ty of L-ELAPE for low rectal cancer. Methods From January 2012 to December 2013, 37 patients with low rectal cancer underwent L-ELAPE （n = 21） and L-Miles （n = 16） operations. Operative dura- tion, blood loss volume, complication rate of perineal wound and postoperative hospital stay were analyzed retrospectively. Results There were 21 patients in L-ELAPE group and 16 patients in L-Miles group. No significant inter-group difference existed in blood loss volume, complication rate of perineal wound and postoperative hospital stay. Operative duration in L-ELAPE group was longer than that in L-Miles group （P〈0. 05）. Conclusions L-ELAPE is a safe and feasible operation for low rectal cancer. But it has a longer operative duration than that of L-Miles operation.