个体化经肛提肌外腹会阴联合切除术治疗低位进展期直肠癌的探索

Results of individual extralevator abdominoperineal resection for locally advanced low rectal cancer

目的探讨个体化经肛提肌外腹会阴联合切除术(extralevator abdominoperineal excision,ELAPE)治疗低位进展期直肠癌的疗效。方法 2011年6月至2015年6月,在术前磁共振成像(magnetic resonance imaging,MRI)精准指导下,56例低位进展期直肠癌患者接受个体化ELAPE。观察肿瘤环周切缘、术中穿孔、术后合并症和局部复发情况。结果术前50例(89.3%)患者接受新辅助治疗。无围术期死亡病例,术后常见合并症包括:会阴伤口感染(9/56,16.1%)、性功能障碍(5/41,12.2%)、尿潴留(4/56,7.1%)和慢性会阴部疼痛(3/56,5.4%)。术后环周切缘(circumferential resection margin,CRM)阳性3例(5.4%),术中肠管穿孔2例(3.6%)。平均随访35个月(12~60个月),局部复发2例(3.6%)。结论在新辅助治疗和术前MRI的精准指导下,在不影响手术根治性的前提下,个体化ELAPE是治疗低位进展期直肠癌的安全可行技术。

Objective To evaluate the safety and efficacy of individualized extralevator abdominoperineal excision （ ELAPE） for locally advanced low rectal cancer. Methods Fifty-six patients w,ho underwent individualized abdominoperineal resection （AP R） based on magnetic resonance imaging （MRI） from June 2011 to June 2015 were evaluated. The main outcome measures were circumferential resection margin involvement,intraoperative perforation,postoperative complications,and local recurrence. Results During the study, fifty patients （89. 3% ） received preoperative chemoradiotherapy. The common complications included perineal wound infection （9/56, 16. 1%）,sexual dysfunction （5/41 ,12. 2%）,urinary retention （4/56 ,7. 1 %） and chronic perineal pain （ 3 /5 6 ,5. 4 % ） . A positive circumferential resection margin （CRM） was demonstrated in 3 （5. 4% ） patients,and intraoperative perforations occurred in 2 （3. 6% ） patient. The local recurrence was 3. 6% at a median follow-up of 35 months （range,1 2 - 6 0 months）. Conclusion With adequate preoperative chemoradiotherapy and MRI precise guideline, individualized ELAPE might be a relatively safe and feasible approach forlocally advanced low rectal cancer with acceptable oncological outcomes.