直肠癌柱状经腹会阴切除术6例  

Cylindrical abdominoperineal resection for advanced low rectal cancer:a report of 6 cases

作　　者：姜金波[1] 李雪梅[2] 曲辉[1] 戴勇[1] 姜旭生[1] 靳祖涛[1] 

机构地区：[1]山东大学齐鲁医院普外科,山东济南250012 [2]山东大学医学院,山东济南250012

出　　处：《中国现代普通外科进展》2010年第4期262-265,共4页Chinese Journal of Current Advances in General Surgery

基　　金：山东省优秀中青年科学家科研奖励基金计划(BS2009YY032);山东大学自主创新基金自然科学类专项(2009TS056)

摘　　要：目的:介绍直肠癌柱状经腹会阴切除术(柱状APR)的应用体会。方法:山东大学齐鲁医院普外科2009年2月—2009年5月采用柱状APR治疗6例低位直肠癌患者。采用Holm等描述的手术过程,按TME技术要求游离直肠系膜,向下游离到肛提肌的起点处停止,结肠造瘘,关闭腹部切口。翻转患者置于俯卧位,实施扩大的会阴部切除,沿外括约肌、耻骨直肠肌、肛提肌外表面游离到肛提肌的盆壁起始处,即腹部向下游离的终点下方,后方自尾骨骶骨连接处切开,进入骶前,然后由后至前,将肛提肌自起始处离断。结果:柱状APR切除更多远端直肠周围组织,所有患者无直肠穿孔,会阴刀口均一期愈合,1例患者出现会阴血清肿,1例患者出现盆底腹膜疝。结论:柱状APR可以切除更多的低位直肠癌瘤周组织,减少术中穿孔,降低环周切缘阳性率。Objective：To introduce the method of cylindrical abdominoperineal resection（APR）for low rectal cancer.Methods：Cylindrical APR was performed for 6 patients with advanced ultralow rectal cancer according to standard protocol in Stockholm from February to May in 2009.The procedure involved careful mobilization of the mesorectum as low as the origins of the levator muscle.After stoma formation,the abdomen was closed,the patient was rotated into the prone position,and an extended perineal dissection was performed.This included the sphinctercomplex and followed the inferior surface of the levators to a point laterally where they originated on the pelvic sidewall.This point should be just inferior to the level where the abdominal procedure was terminated.Results：The cylindrical technique removed more tissue in the distal rectum.There was no bowel perforation,perineal wounds were uneventfully.One patient developed perineal seroma.One patient developed peritoneocele hernia of pelvic floor.Conclusion：Cylin-drical APR performed in the prone position for low rectal cancer removes more tissue around the tumor that leads to a reduction in CRM involvement and intraoperative perforations,which should reduce local disease recurrence.

关 键 词：直肠肿瘤 状经腹会阴切除术 科手术 

分 类 号：R735.37[医药卫生—肿瘤]