肛提肌外腹会阴联合切除术联合生物补片盆底重建治疗直肠癌的临床研究

Clinical study on the treatment of rectal cancer with the combination of the external abdominal perineal resection and the pelvic floor reconstruction

目的 探讨肛提肌外腹会阴联合切除术联合生物补片盆底重建治疗直肠癌的临床效果.方法 选取2012年6月至2014年9月106例直肠癌患者为研究对象,采用随机数表法将患者分为观察组与对照组,每组53例.对照组采用肛提肌外腹会阴联合切除术治疗,观察组采用肛提肌外腹会阴联合切除术联合生物补片盆底重建治疗,比较两组手术一般指标、术后1个月盆底功能恢复情况及远期随访效果.结果 观察组手术时间、术中出血量分别为（259.58±42.07）min、（226.75±21.06）ml,显著高于对照组[（210.64±29.24）min、（181.23±42.15）ml,P〈0.05],住院时间[（17.65±6.33）d]与对照组[（16.89±6.27）d]比较差异未见计学意义（P〉0.05）;观察组术后会阴切口裂开、切口未愈、切口延迟愈合、会阴疝发生率分别为1.89%、0%、3.77%、0%,显著低于对照组的15.09%、7.55%、16.98%、7.55%（P〈0.05）;随访1年发现,观察组肿瘤局部复发率及远处转移率分别为3.77%、7.55%,与对照组（5.66%、11.32%）比较差异均未见统计学意义（P〉0.05）,且观察组未出现生物补片感染、磨损、侵蚀及排斥反应等不良反应.结论 肛提肌外腹会阴联合切除术联合生物补片盆底重建治疗直肠癌与单纯肛提肌外腹会阴联合切除术相比手术时间较长,术中出血量较多,但手术同时可修复患者盆底结构,可显著降低患者术后会阴切口相关并发症的发生率,且远期随访效果与单纯肛提肌外腹会阴联合切除术相当,值得在临床推广应用.

Objective To investigate the clinical effect of the external abdominal perineal resection combined with pelvic floor reconstruction on rectal cancer. Methods One hundred and six patients with rectal cancer from June 2012 to September 2014 were selected as the research object,using a random number table method,they were divided into observation group and control group,with 53 cases in each group. The control group underwent extralevator abdominoperineal resection,the observation group with extralevator abdominoperineal resection combined with biological mesh pelvic floor reconstruction treatment. The general surgical indicators,recovery of pelvic floor function 1 months after operation and long term follow-up were compared between the two groups. Results The operation time,intraoperative hemorrhage in observation group were （259.58±42.07）min,（226.75±21.06） ml respectively,which were more than those in the control group,there were significant differences （P〈0.05）; the hospitalization time was longer than that in control group,there was no significant difference（P〉0.05）; in observation group,the incidence of perineal incision dehiscence,unhealing of incision,delayed healing of incision and perineal hernia were lower than those in control group,there were significantly differences （P〈0.05）; After 1 year of follow-up,the local tumor recurrence and distant metastasis rate were 3.77%,7.55% in the observation group,were lower than those in control group,there were no significant differences （P〉0.05）. The observation group had no adverse reaction of biological patch infection,abrasion,erosion and rejection. Conclusions Extralevator abdominoperineal resection combined with biological mesh pelvic floor reconstruction in treatment of rectal cancer compared with simple extralevator abdominoperineal resection,with longer operative time, more intraoperative bleeding,but can repair patients’ pelvic structure, significantly reduce the incidence of postoperative complications of perineal incision,and long term follow-up results are similar to those of simple external abdominal perineal resection,so it is worthy of clinical application.