肛提肌外腹会阴联合切除术治疗直肠癌的临床效果分析

Clinical effectiveness of Extralevator Abdomenperineal Excision in rectal cancer

目的探讨肛提肌外腹会阴联合切除术(ELAPE)治疗直肠癌的临床效果。方法回顾性分析本院90例直肠癌患者的临床资料,按照手术方式的不同将其分为观察组与对照组,其中观察组行ELAPE,对照组行传统腹会阴联合切除术(APE),每组各45例。对比两组手术相关指标(手术时间、术中出血量、排气时间、排便时间、禁食时间、会阴切口拆线时间、会阴切口平均引流量、术后住院时间、淋巴结清扫数目、环周切缘阳性率、术中穿孔率),观察两组术后并发症发生率,采用Kaplan-Meier生存曲线分析两组术后3年生存率。结果两组术中出血量、排气时间、排便时间、禁食时间、会阴拆线时间、会阴平均引流量、术后住院时间、淋巴结清扫数目比较差异均无统计学意义(均P>0.05)。观察组手术时间长于对照组,环周切缘阳性率、术中穿孔率均低于对照组,差异均有统计学意义(均P<0.05)。观察组会阴切口并发症发生率低于对照组(P<0.05),两组性功能障碍、尿潴留、骶尾部慢性疼痛发生率差异均无统计学意义(均P>0.05)。观察组术后3年生存率高于对照组(P<0.05)。结论与传统APE术相比,ELAPE治疗直肠癌安全可行,可降低环周切缘阳性率、术中穿孔率,提高患者生存率,还可降低会阴切口并发症发生率,具有较好的临床应用前景。

Objective To evaluate clinical effectiveness of extralevator abdomenperineal excision（ELAPE） for rectal cancer. Methods The clinical data of 90 cases of rectal cancer in our hospital were retrospectively analyzed. The treatment group received ELAPE and the control group received traditional abdominal perineal resection（APE）. The operation-related indices（operation duration, the amount of intraoperative bleeding, recovery time for anal exsufflation and defecation, duration of fasting, time to perineal incision off stitches, amount of perineal incision drainage, postoperative hospitalization duration, number of lymph node dissection, the positive rate of circumferential resection margin, and perforation rate） were compared between the two groups. The incidence of postoperative complications was recorded, and the 3-year survival rate was compared between groups by Kaplan-Meier analysis. Results There was no significant difference between the two groups in the amount of bleeding, recovery time for anal exsufflation and defecation, duration of fasting, time to perineal incision off stitches, average amount of perineal incision drainage, postoperative hospitalization duration and the number of lymph node dissection（P〈0.05）. The operation duration was longer and the positive rate of circumferential resection margin and the perforation rate were lower in the treatment group than in the control group（P〈0.05）. The incidence of complications of perineal incision was lower in the treatment group than in control group（P〈0.05）. There was no significant difference in the incidence of sexual dysfunction, urinary retention and chronic sacrocoxalgia between the two groups（P〈0.05）. The 3-year survival rate was higher in the treatment group than in the control group（P〈0.05）. Conclusion Compared with traditional APE, ELAPE is a safe operation. It can lower the positive rate of circumferential resection margin, intraoperative perforation rate, and improve the survival rate of patients. It can also reduce the incidence of complications of perineal incision. It has a high potential for clinical application