Extralevator abdominoperineal excision for advanced low rectal cancer:Where to go

Since its introduction,extralevator abdominoperineal excision(ELAPE)in the prone position has gained significant attention and recognition as an important surgical procedure for the treatment of advanced low rectal cancer.Most studies suggest that because of adequate resection and precise anatomy,ELAPE could decrease the rate of positive circumferential resection margins,intraoperative perforation,and may further decrease local recurrence rate and improve survival.Some studies show that extensive resection of pelvic floor tissue may increase the incidence of wound complications and urogenital dysfunction.Laparoscopic/robotic ELAPE and trans-perineal minimally invasive approach allow patients to be operated in the lithotomy position,which has advantages of excellent operative view,precise dissection and reduced postoperative complications.Pelvic floor reconstruction with biological mesh could significantly reduce wound complications and the duration of hospitalization.The proposal of individualized ELAPE could further reduce the occurrence of postoperative urogenital dysfunction and chronic perianal pain.The ELAPE procedure emphasizes precise anatomy and conforms to the principle of radical resection of tumors,which is a milestone operation for the treatment of advanced low rectal cancer.

Abdominoperineal excision following preoperative radiotherapy for rectal cancer: Unfavorable prognosis even with negative circumferential resection margin

AIM: To evaluate whether an abdominoperineal excision(APE) is associated with increased local recurrence(LR) and shortened disease-free survival(DFS) in mid-low rectal cancer with a negative circumferential resection margin(CRM).METHODS: 283 consecutive cases of mid-low rectal cancer underwent preoperative 30 Gy/10 F radiotherapy and surgery in Peking University Cancer Hospital between August 2003 and August 2009. Patients with positive CRM and intraoperative distant metastasis were precluded according to exclusion criteria. Survival analyses were performed in patients with APE or non-APE procedures.RESULTS: 256 of the 283(90.5%) cases were enrolled in the analysis, including 78(30.5%) and 178(69.5%) cases who received APE and non-APE procedures. Fewer female patients(P = 0.016), lower level of tumor(P = 0.000) and higher body mass index(P = 0.006) were found in the APE group. On univariate analysis, the APE group had a higher LR rate(5.1% vs 1.1%, P = 0.036) and decreased DFS(73.1% vs 83.4%, P = 0.021). On multivariate analysis, APE procedure was also an independent risk factor for LR(HR = 5.960, 1.085-32.728, P = 0.040) and decreased DFS(HR = 2.304, 1.298-4.092, P = 0.004). In stratified analysis for lower rectal cancer, APE procedure was still an independent risk factor for higher LR rate(5.6% vs 0%, P = 0.024) and shortened DFS(91.5% vs 73.6%, P = 0.002).CONCLUSION: Following preoperative 30 Gy/10 F radiotherapy, APE procedure was still a predictor for LR and decreased DFS even with negative CRM. More intensive preoperative treatment should be planned for the candidates who are scheduled to receive APE with optimal imaging assessment.

Application of modified primary closure of the pelvic floor in laparoscopic extralevator abdominal perineal excision for low rectal cancer

AIM To introduce a novel,modified primary closure technique of laparoscopic extralevator abdominal perineal excision(LELAPE) for low rectal cancer.METHODS We retrospectively analyzed data from 76 patients with rectal cancer who underwent LELAPE from March 2013 to May 2016.Patients were classified into the modified primary closure group(32 patients) and the biological mesh closure group(44 patients).The total operating time,reconstruction time,postoperative stay duration,total cost,postoperative complications and tumor recur-rence were compared.RESULTS All surgery was successfully performed.The pelvic reconstruction time was 14.6 ± 3.7 min for the modified primary closure group,which was significantly longer than that of the biological mesh closure group(7.2 ± 1.9 min,P < 0.001).The total operating time was not different between the two groups(236 ± 20 min vs 248 ± 43 min,P = 0.143).The postoperative hospital stay duration was 8.1 ± 1.9 d,and the total cost was 9297 ± 1260 USD for the modified primary closure group.Notably,both of these categories were significantly lower in this group than those of the biological mesh closure group(P = 0.001 and P = 0.003,respectively).There were no differences observed between groups when comparing other perioperative data,long-term complications or oncological outcomes.CONCLUSION The modified primary closure method for reconstruction of the pelvic floor in LELAPE for low rectal cancer is technically feasible,safe and cost-effective.

Systematic review of oncological outcomes following laparoscopic vs open total mesorectal excision

AIM: To systematically analyze the randomized trials comparing the oncological and clinical effectiveness of laparoscopic total mesorectal excision(LTME) vs open total mesorectal excision(OTME) in the management of rectal cancer.METHODS: Published randomized, controlled trials comparing the oncological and clinical effectiveness of LTME vs OTME in the management of rectal cancer were retrieved from the standard electronic medical databases. The data of included randomized, controlled trials was extracted and then analyzed according to the principles of meta-analysis using RevMan? statistical software. The combined outcome of the binary variables was expressed as odds ratio(OR) and the combined outcome of the continuous variables waspresented in the form of standardized mean difference(SMD). RESULTS: Data from eleven randomized, controlled trials on 2143 patients were retrieved from the electronic databases. There was a trend towards the higher risk of surgical site infection(OR = 0.66; 95%CI: 0.44-1.00; z = 1.94; P < 0.05), higher risk of incomplete total mesorectal resection(OR = 0.62; 95%CI: 0.43-0.91; z = 2.49; P < 0.01) and prolonged length of hospital stay(SMD,-1.59; 95%CI:-0.86--0.25; z = 4.22; P < 0.00001) following OTME. However, the oncological outcomes like number of harvested lymph nodes, tumour recurrence and risk of positive resection margins were statistically similar in both groups. In addition, the clinical outcomes such as operative complications, anastomotic leak and all-cause mortality were comparable between both approaches of mesorectal excision.CONCLUSION: LTME appears to have clinically and oncologically measurable advantages over OTME in patients with primary rectal cancer in both short term and long term follow ups.

Application of Laparoscopic Extralevator Abdominoperineal Excision in Locally Advanced Low Rectal Cancer

Background：When compared with conventional abdominoperineal resection （APR）,extralevator abdominoperineal excision （ELAPE） has been demonstrated to reduce the risk of local recurrence for the treatment of locally advanced low rectal cancer.Combined with the laparoscopic technique,laparoscopic ELAPE （LELAPE） has the potential to reduce invasion and hasten postoperative recovery.In this study,we aim to investigate the advantages of LELAPE in comparison with conventional APR.Methods：From October 2010 to February 2013,23 patients with low rectal cancer （T3-4N0-2M0） underwent LELAPE;while during the same period,25 patients were treated with conventional APR.The patient characteristics,intraoperative data,postoperative complications,and follow-up results were retrospectively compared and analyzed.Results：The basic patient characteristics were similar;but the total operative time for the LELAPE was longer than that of the conventional APR group （P =0.014）.However,the operative time for the perineal portion was comparable between the two groups （P =0.328）.The LELAPE group had less intraoperative blood loss （P =0.022）,a lower bowel perforation rate （P =0.023）,and a positive circumferential margin （P =0.028）.Moreover,the patients,who received the LELAPE,had a lower postoperative Visual Analog Scale,quicker recovery of bowel function （P =0.001）,and a shorter hospital stay （P =0.047）.However,patients in the LELAPE group suffered more chronic perineal pain （P =0.002）,which may be related to the coccygectomy （P =0.033）.Although the metastasis rate and mortality rate were similar between the two groups,the local recurrence rate of the LELAPE group was statistically improved （P =0.047）.Conclusions：When compared with conventional APR,LELAPE has the potential to reduce the risk of local recurrence,and decreases operative invasion for the treatment of locally advanced low rectal cancer.

Preliminary Outcome of Individualized Abdominoperineal Excision for Locally Advanced Low Rectal Cancer

Background： The introduction of individualized abdominoperineal excision （APE） may minimize operative trauma and reduce the rate of complications. The purpose of this study was to evaluate the safety and efficacy of individualized APE for low rectal cancer. Methods： Fifty-six patients who underwent individualized APE from June 2011 to June 2015 were evaluated retrospectively in Beijing Chaoyang Hospital, Capital Medical University. The main outcome measures were circumferential resection margin （CRM） involvement, intraoperative perforation, postoperative complications, and local recurrence. Statistical analysis was performed using SPSS version 16.0. Results： Fifty （89%） patients received preoperative chemoradiotherapy： 51 （91%） patients were treated with the sacrococcyx preserved; 27 （48%） patients with the levator ani muscle partially preserved bilaterally; 20 （36%） patients with the levator ani muscle partially preserved unilaterally and the muscle on the opposite side totally preserved; 7 （13%） patients with intact levator ani muscle and part of the ischioanal fat bilaterally dissected; and 2 （4%） patients with part of the ischioanal fat and intact lavator ani muscle dissected unilaterally and the muscle on the opposite side partially preserved. The most common complications included sexual dysfunction （12%）, perineal wound complications （13%）, urinary retention （7%）, and chronic perineal pain （5%）. A positive CRM was demonstrated in 3 （5%） patients, and intraoperative perforations occurred in 2 （4%） patients. On multiple logistic regression analysis, longer operative time （P = 0.032） and more intraoperative blood loss （P = 0.006） were significantly associated with perineal procedure-related complications. The local recurrence was 4% at a median follow-up of 53 months （range： 30–74 months）. Conclusion： With preoperative chemoradiotherapy, individualized APE may be a relatively safe and feasible approach for low rectal cancer with acceptable oncological outcomes.

Extralevator abdominoperineal excision versus abdominoperineal excision for low rectal cancer: a meta-analysis

Background:Extralevator abdominoperineal excision (ELAPE) has become a popular procedure for low rectal cancer as compared with abdominoperineal excision (APE). No definitive answer has been achieved whether one is superior to the other. This study aimed to evaluate the safety and efficacy of ELAPE for low rectal cancer with meta-analysis.Methods:The Web of Science, Cochrane Library, Embase, and PubMed databases before September 2019 were comprehensively searched to retrieve comparative trials of ELAPE and APE for low rectal cancer. Pooled analyses of the perioperative variables, surgical complications, and oncological variables were performed. Odds ratio (OR) and mean differences (MD) from each trial were pooled using random or fixed effects model depending on the heterogeneity of the included studies. A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.Results:This meta-analysis included 17 studies with 4049 patients, of whom 2248 (55.5%) underwent ELAPE and 1801 (44.5%) underwent APE. There were no statistical differences regarding the circumferential resection margin positivity (13.0% vs. 16.2%, OR = 0.69, 95% CI = 0.42-1.14, P = 0.15) and post-operative perineal wound complication rate (28.9% vs. 24.1%, OR = 1.21, 95% CI = 0.75-1.94, P= 0.43). The ELAPE was associated with lower rate of intraoperative perforation (6.6% vs. 11.3%, OR = 0.50, 95% CI = 0.39-0.64, P < 0.001) and local recurrence (8.8% vs. 20.5%, OR = 0.29, 95% CI = 0.21-0.41, P < 0.001) when compared with APE.Conclusions:The ELAPE was associated with a reduction in the rate of intra-operative perforation and local recurrence, without any increase in the circumferential resection margin positivity and post-operative perineal wound complication rate when compared with APE in the surgical treatment of low rectal cancer.

Transanal total mesorectal excision combined with intersphincteric resection has similar long-term oncological outcomes to laparoscopic abdominoperineal resection in low rectal cancer:a propensity score-matched cohort study

Background Transanal total mesorectal excision(taTME)or intersphincteric resection(ISR)has recently proven to be a valid and safe surgical procedure for low rectal cancer.However,studies focusing on the combination of these two technologies are limited.This study aimed to evaluate perioperative results,long-termoncologic outcomes,and anorectal functions of patients with low rectal cancer undergoing taTME combined with ISR,by comparing with those of patients undergoing laparoscopic abdominoperineal resection(laAPR).Methods After 1:1 propensity score matching,200 patients with low rectal cancer who underwent laAPR(n=100)or taTME combined with ISR(n=100)between September 2013 and November 2019 were included.Patient demographics,clinicopathological characteristics,oncological outcomes,and anal functional results were analysed.Results Patients in the taTME-combined-with-ISR group had less intraoperative blood loss(79.6672.6 vs 107.3665.1 mL,P=0.005)and a lower rate of post-operative complications(22.0%vs 44.0%,P<0.001)than those in the laAPR group.The overall local recurrence rates were 7.0%in both groups within 3 years after surgery.The 3-year disease-free survival rates were 86.3%in the taTME-combined-with-ISR group and 75.1%in the laAPR group(P=0.056),while the 3-year overall survival rates were 96.7%and 94.2%,respectively(P=0.319).There were 39 patients(45.3%)in the taTME-combined-with-ISR group who developed major low anterior resection syndrome,whereas 61 patients(70.9%)had good post-operative anal function(Wexner incontinence score≤10).Conclusion We found similar long-term oncological outcomes for patients with low rectal cancer undergoing laAPR and those undergoing taTME combined with ISR.Patients receiving taTME combined with ISR had acceptable post-operative anorectal function.

直肠癌腹会阴联合切除术后造口旁疝发生的危险因素分析

目的:探讨直肠癌腹会阴联合切除(APR)术后造口旁疝发生的影响因素。方法:回顾性分析2008年1月-2018年12月于我院普外科行APR的163例低位直肠癌患者的临床资料。随访术后造口旁疝的发生情况,对可能影响造口旁疝发生的因素进行单因素分析和多因素Logistic回归分析。结果:163例行APR的直肠癌患者,术后有29例出现造口旁疝,造口旁疝的发生率为17.79%;其中Ⅰ型19例(65.52%),Ⅱ型4例(13.79%),Ⅲ型4例(13.79%),Ⅳ型2例(6.90%)。造口旁疝发生的时间为术后5~30个月,中位时间18个月。单因素分析显示,年龄≥65岁、BMI≥28 kg/m^(2)、经腹腔途径造口、手术时间>4 h与APR术后造口旁疝的发生相关(P<0.05)。多因素Logistic回归分析显示,BMI≥28 kg/m^(2)是APR术后造口旁疝发生的独立危险因素(OR=4.202,P<0.05)。结论:BMI≥28 kg/m^(2)是APR术后造口旁疝发生的独立危险因素。针对肥胖的低位直肠癌患者,应采取合理的预防及治疗措施,以期减少APR术后造口旁疝的发生。

经肛提肌外腹会阴联合切除术与传统腹会阴联合切除术在低位直肠癌根治术中优越性比较的Meta分析

目的:经肛提肌外腹会阴联合切除术(extralevator abdominoperineal excision,ELAPE)治疗低位直肠癌可提高手术安全性和生存率仍存在争议。用Meta分析比较ELAPE与传统腹会阴联合切除术(conventional abdominoperineal excision,APE)在低位直肠癌根治术中的优越性。方法:在线检索Pub Med,Embase和Cochrane Library以及中国生物医学文献数据库、中国期刊全文数据库和万方数字化期刊全文数据库中ELAPE组与APE组术中穿孔率,切缘阳性率,局部复发率,术后并发症等相关的病例对照研究或队列研究,采用Ren Man 5.2软件对入选研究进行Meta分析。结果:共纳入10篇文献,ELAPE组术中穿孔率(MD=0.54,95%CI:0.31~1.39,P=0.03)和局部复发率(MD=0.30,95%CI:0.21~0.42,P<0.001)明显低于APE组。两组切缘阳性率(P=0.07)的差异无统计学意义。结论:通过会阴缺口的修补和个体化治疗可以改善ELAPE组术后生活质量。ELAPE术式治疗低位直肠癌较APE术式有一定优势,但应注重个体化治疗。同时建议开展大样本、多中心、中长期的随机对照研究,明确该术式的肿瘤学效果。

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

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。

不同手术入路顺序的腹腔镜下肛提肌外腹会阴联合切除术的对比分析

目的：比较不同手术入路顺序的腹腔镜下肛提肌外腹会阴联合切除术（laparoscopic extralevator abdominoperineal excision，LELAPE）的优缺点。方法：回顾分析2013年2月至2015年9月30例接受LELAPE的低位直肠癌患者的临床资料，将其分为两组，腹部优先组14例，其中男7例，女7例，平均（61±6．4）岁；会阴优先组16例，其中男10例，女6例，平均（63±8．2）岁。应用t检验或x2检验对比分析两组患者术中情况及术后恢复情况。结果：腹部优先组的腹部及会阴操作时间分别为（74．6±4．765）min与（55．79±5．07）min，术中出血量平均（85．0±9．4）ml，术后平均住院（9．0±1．664）d。会阴优先组的腹部及会阴操作时间分别为（56．88±4．44）min与（72．0±4．775）min，术中出血量平均（80．5±11．2）ml，术后平均住院（10．0±2．191）d。腹部优先组的腹部操作时间较会阴优先组明显延长（P〈0．01），而会阴优先组的会阴操作时间较腹部优先组明显延长（P〈0．01）。两组患者术中出血量、术后会阴部切口局部并发症及术后住院时间差异均无统计学意义（P〉0．05）。结论：两种不同手术入路顺序的LELAPE均是安全、可行的，会阴优先更适合复杂的LELAPE操作，更能体现其优势。

改良腹腔镜肛提肌外腹会阴联合切除术治疗低位直肠癌

目的:评价改良腹腔镜经肛提肌外腹会阴联合切除术的安全性与可行性。方法:回顾分析2013年8月至2015年2月为21例低位直肠癌患者施行腹腔镜经肛提肌外腹会阴联合切除术的临床资料,术中根据肿瘤浸润程度行侧方完全或不完全切除肛提肌,尽可能使腹会阴手术交汇平面下移,无需改变患者体位,通过会阴部切口去除标本,腹腔镜下缝合关闭盆底腹膜,以预防肠管下坠造成内疝。观察手术时间、术中出血量、淋巴结获取数量、术后并发症等指标。结果:操作均成功完成,无中转手术及术中并发症、腹腔镜相关并发症发生。手术时间平均(186.1±32.5)min,术中出血量平均(149.6±26.7)ml;淋巴结获取数量(15.3±6.4)枚;标本上的肛提肌个体化地附着在直肠系膜上,环周切缘均阴性。结论:术中不更换患者体位,在腹腔镜下完成柱状腹会阴联合切除术是可行的,且具有肿瘤学效果好、并发症少的优点。

肛提肌外腹会阴联合切除术对低位直肠癌病人近期预后的影响

目的:探讨肛提肌外腹会阴联合切除术(extralevator abdominoperineal excision,ELAPE)对低位直肠癌病人近期预后影响,为改善低位直肠癌病人近期预后提供参考依据。方法:收集低位直肠癌病人67例,根据不同手术方式分为传统腹会阴联合切除术(abdomino-perineal resection,APE)组(n=31)和ELAPE组(n=36)。比较2组病人的手术情况、术后恢复情况、发症发生率及术后随访结果。结果:ELAPE组手术时间明显高于APE组,术中出血量、环周切缘阳性率均显著低于APE组(P <0. 05～P <0. 01); 2组病人淋巴结清扫数目和术中穿孔率差异无统计学意义(P> 0. 05); ELAPE组会阴引流管拔除时间明显高于APE组(P <0. 05); 2组病人排气时间、排便时间、进食流质时间、会阴引流量、住院时间、会阴伤口拆线时间差异均无统计学意义(P> 0. 05);术后随访6～24个月,ELAPE组远处转移率和死亡率均明显低于APE组(P <0. 01和P <0. 05),2组局部复发率差异无统计学意义(P> 0. 05)。结论:与传统APE比较,ELAPE减少了低位直肠癌病人术中出血量,并降低了环周切缘阳性、远处转移及死亡发生率,明显改善了病人近期预后,值得临床重视。

直肠癌腹腔镜肛提肌外腹会阴切除术的体位护理配合的探讨

目的:探讨腹腔镜辅助直肠癌柱状/肛提肌外腹会阴切除术(ELAPE)的体位护理配合方式。方法:2008年1月至2013年4月,我院对35例进展期低位直肠癌患者施行了腹腔镜辅助直肠癌ELAPE。其中男性18例,女性17例,平均年龄67岁。肿瘤距离肛缘平均3.8cm。术前经MRI检查分期,T3期19例,T4期16例。35例患者先采取平卧分腿位在腹腔镜下游离病变肠管再俯卧折刀位经骶尾部行直肠癌根治术,术中采用变换体位护理配合。结果:术中变换体位护理配合,使35例手术均顺利完成,无压疮、感染等并发症的发生。结论:充分的体位准备,熟练的术中配合及病情观察,合理的体位摆放和转换是保证腹腔镜辅助直肠癌柱状/ELAPE顺利进行的关键。

腔镜下在腹会阴联合直肠切除术在治疗低位直肠癌中的应用

目的:探讨腹腔镜腹会阴联合直肠切除术(laparoscopic abdominoperineal resection,LAPR)治疗低位直肠癌的可行性、安全性、根治性及近期疗效。方法:对16例低位直肠癌患者经腹腔镜实施腹会阴联合切除术的临床资料进行回顾性分析。结果:16例患者中15例均成功完成手术,1例中转开腹。手术时间180～300min,平均260 min,术中出血20～80 ml,平均出血量40 ml。术后住院(不包括化疗时间)7～10 d,平均为8d。术后胃肠功能恢复时间12～36 h,无手术死亡、输尿管损伤、骶前出血、切口感染等并发症。患者术后随访至今5～16个月,无复发转移情况。结论:腹腔镜下腹会阴联合切除术治疗低位直肠癌已成为安全可行的手术方式,并具有出血少、恢复快、住院时间短等优点。

腹腔镜经肛提肌外腹会阴联合切除术治疗低位进展期直肠癌疗效观察

目的比较腹腔镜经肛提肌外腹会阴联合切除术(ELAPE)和传统腹会阴联合切除术(APR)治疗低位进展期直肠癌的临床疗效。方法回顾性分析资阳市第一人民医院胃肠外科及四川大学华西医院胃肠中心2015年1月至2017年12月期间收治的15例行腹腔镜下ELAPE和12例行APR治疗的低位进展期直肠癌患者的临床资料,比较两组患者年龄、性别、分期、肿瘤距离肛缘的距离、肿瘤的位置、是否行新辅助治疗、手术时间、术中出血量、术中穿孔率、环周切缘(CRM)阳性率和术后并发症的差异。结果两组患者均顺利完成手术,无中转开腹者;ELAPE组患者的所有标本呈柱状,肛提肌均附着在直肠系膜上,APR组可见"外科腰";两组患者在性别、年龄、肿瘤下缘距肛缘距离、位置、TNM分期、是否术前化疗、手术时间和术中出血量方面比较差异均无统计学意义(P>0.05);ELAPE组和APR组患者发生直肠穿孔的例数分别为1例和4例,穿孔率分别为6.67%、33.33%,CRM阳性例数分别为2例和5例,阳性率分别为13.33%、41.67%,差异均有统计学意义(P<0.05)。结论腹腔镜下ELAPE较ARP具有暴露好、解剖精细等优点,可降低CRM阳性率及术中穿孔率,复发率低,提高总体生存率。

腹腔镜提肛肌外腹会阴联合切除术治疗低位直肠癌的临床应用

目的:探讨腹腔镜提肛肌外腹会阴联合切除术(laparoscopic extralevator abdominoperineal excision,LELAPE)治疗低位直肠癌的临床效果。方法:回顾分析2011年6月至2013年1月为15例低位直肠癌患者行LELAPE的临床资料。结果:手术均顺利完成,手术时间平均(258.8±52.1)min,术中出血量平均(130±48.4)ml,术中未发生医源性肠管穿孔,切除标本为"柱状",无"外科腰"。术后下床活动时间平均(35.1±12.5)h,肠功能恢复时间平均(60.6±24.5)h,会阴部引流管拔除时间平均(6.2±1.5)d,会阴部切口拆线时间平均(15.6±2.52)d,术后平均住院(12.1±3.4)d;术后未发生排尿障碍及勃起障碍;1例发生会阴部切口延迟愈合,1例发生不全肠梗阻,经对症治疗后痊愈出院。无死亡病例。患者均获随访,随访1～19个月,无复发及死亡病例。结论:LELAPE可降低标本环周切缘阳性率及术中标本穿孔率,改善预后,未增加并发症发生率及会阴部创伤,为术者提供了良好的手术视野。LELAPE治疗低位直肠癌是安全、可行、理想的术式。

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

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。

低位直肠癌高热柱状腹会阴联合切除技术的临床研究

目的总结低位直肠癌高热无瘤柱状腹会阴切除术(cylindrical abdominoperineal resection,CAPR)的临床操作方法和治疗优势。方法对我院2007-06～2009-01盆腔遵从TME原则、会阴部柱状切除的75例低位直肠癌患者的根治性切除术方法、并发症及疗效等临床资料进行回顾性总结分析。结果手术全程采取膀胱截石体位,盆腔TME联合会阴部扩大柱状切除,无肠破裂穿孔,69例病理示环周切缘阴性(92.0%),3例会阴伤口感染(4.0%)。全组68例获随访(90.7%),随访时间36-48个月,3例局部癌复发(4.0%),4例患者术后肝脏转移(5.2%),无会阴刀口疝发生。结论柱状腹会阴切除是低位进展期直肠癌不保肛手术操作应遵循的原则,高热无瘤切除理念的引入是降低术后局部癌复发的重要技术变革。