低位直肠癌经肛提肌外腹会阴联合切除术与传统术式的疗效比较

Comparison of extralevator abdominoperineal excision vs.abdominoperineal resection for low rectal cancer

目的比较腹会阴直肠癌根治术与传统腹会阴直肠癌根治术(APR)治疗低位直肠癌的并发症及短期手术效果。方法回顾性分析2012年1月至2015年9月54例行低位进展期直肠癌手术病人的临床资料,20例病人接受传统APR手术(APR组),34例接受肛提肌外腹会阴直肠癌根治术(ELAPE组)。结果与传统APR组比较,ELAPE组术中出血量较少,术中标本穿孔率及环周切缘阳性率低,差异有统计学意义(P<0.05);与传统APR比较,ELAPE组术后会阴切口并发症发生率、尿潴留发生率更高,手术时间较长,差异有统计学意义(P<0.05)。经过短期随访,ELAPE组1例出现复发,无死亡病例;传统APR组盆底复发1例,死亡1例。两组局部复发率及死亡率比较差异无统计学意义(P>0.05)。结论 ELAPE手术虽然在一定程度上增加了会阴区相关并发症的发生率,但其明显降低了术中直肠穿孔率和术后标本环周切缘(CRM)阳性率,减少术中出血量,提高了手术根治效果,具有非常重要的临床价值。

Objective To investigate the complications and efficacy of extralevator abdomino- perineal excision （ELAPE） for advanced low rectal cancer. Methods The clinical data of 54 patients with advanced low rectal cancer were retrospectively analyzed, including 34 cases undergoing ELAPE and 20 cases undergoing abdominoperineal resection （APR）. Results The differences in intraoperative blood loss, positive circumferential resection margin （CRM）, and bowel perforation rate were signifi- cant between the ELAPE group and APR group （P〈0. 05）. As compared with the APR, ELAPE could significantly reduce the occurrence of intraoperative perforation, the positive rate of CRM and the amount of bleeding during surgery （P〈0. 05）. As compared with the APR, ELAPE could in- crease the incidence of perineal wound complications and the occurrence rate of urinary retention, and prolong the operation time, with the difference being statistically significant between two groups （P〈 0. 05）. After a short period of follow-up, there were neither postoperative perineal prolapse and pelvic floor hernia; there was no significant difference in the rate of postoperative local recurrence and mor- tality rate （P〈0. 05）. Conclusions Although the ELAPE could increase the incidence of complications associated with the perineal area to some extents, it significantly reduces the intraoperative rectal per- foration rate, postoperative specimen＇s CRM rate and the amount of bleed during the surgery. The ELAPE surgery has an extremely important clinical value.