肛提肌外腹会阴联合切除术治疗低位进展期直肠癌的临床研究

Clinical Study of Extralevator Abdominoperineal Excision for Advanced Lower Rectal Cancer

目的:探讨肛提肌外腹会阴联合切除术(ELAPE)在低位进展期直肠癌中的应用。方法:回顾性分析2011年1月至2013年12月我院胃肠外科30例接受ELAPE和18例接受传统腹会阴联合直肠癌切除术(APR)的低位直肠癌病人的临床资料,通过对手术用时、失血量、术中穿孔发生率、术后住院时间、术后并发症以及出院后随访相关指标等的比较来分析ELAPE的可行性。结果:和APR相比,ELAPE治疗低位直肠癌可降低术中直肠穿孔和CRM阳性的发生率,术后会阴部切口愈合延迟率以及出院后肿瘤局部复发、远处转移以及患者死亡的发生率,差异均有统计学意义(P<0.05)。行ELAPE术的手术时间、术中出血量、平均住院天数,术后引流管拔管时间、尿潴留发生率以及出院随访的骶尾部不适率均稍大于行APR术的患者,但差异均尚无统计学意义(P>0.05);进行两种手术的患者住院两组间围手术期死亡病例、会阴部血清肿的发生率、肠梗阻发生率、造口问题发生率以及出现并发症的情况差异不大(P>0.05)。结论:和APR相比,ELAPE治疗低位进展期直肠癌可降低术中肠管穿孔发生率、CRM阳性率和住院期间发生会阴部切口愈合延迟率,短期随访预后良好,有望成为治疗进展期低位直肠癌的推荐术式。

Objective： To explore the preliminary application of the ELAPE for advanced low rectal cancer. Methods： The clinical data of 30 cases received ELAPE and 18 patients who underwent APR in January 2011 to December 2013 were collected for a retrospective analysis. The operation time, blood loss, intraoperative, postoperative hospital stay, postoperative complications and the related parameters of follow-up after discharge were analyzed. Results： Compared with the traditional APR,ELAPE could significantly reduce the occurrence of intraoperative perforation,tumor local recurrence, distant metastasis rate and the death rate of patients, the positive rate of CRM and the perineal incision delayed healing, the differences were statistically significant（P0.05）. Compared with the APR, ELAPE＇s operation time, intraoperative blood loss, average hospitalization days, postoperative drainage tube extubation time,incidence of urinary retention and discharge follow-up rate of sacral tail discomfort were bigger, but the differences were not statistically significant（P0.05）. There were no obvious difference between these two kinds of surgeries in patients＇ death occurrence in perioperative period, the incidence of perineum seroma, incidence of intestinal obstruction, colostomy and complications incidence（P0.05）. Conclusion： The ELAPE utilized for advanced low rectal cancer can reduce the incidence of intraoperative perforation,positive rate of CRM, and the perineal incision delayed healing, it has better prognosis of short-term follow-up. It may become the recommended operation for advanced low rectal cancer.