低位直肠癌肛提肌外腹会阴联合直肠切除术后的盆底修复  

Perineal reconstruction after extralevator abdominoperineal excision （ELAPE） for carcinoma at the lower rectum

作　　者：王振军[1] 韩加刚[1] 

机构地区：[1]首都医科大学附属北京朝阳医院普通外科,100020

出　　处：《中华胃肠外科杂志》2014年第6期540-543,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：首都临床特色应用研究（Z121107001012131）;北京市卫生系统高层次卫生技术人才培养计划（2009-1-03）;新世纪百千万人才工程（09-911-002;08-009）;首都医学发展科研基金（2009-3109）

摘　　要：肛提肌外腹会阴联合直肠切除术（ELAPE）是近年来提出的治疗低位进展期直肠癌的重要术式。由于ELAPE切除了更多的肿瘤周围组织．从而降低了环周切缘阳性率、肿瘤穿孔率和局部复发率，进一步提高了患者的生存率。但其形成的盆底巨大缺损增加了会阴伤口相关的并发症，因此，ELAPE术后盆底巨大缺损的修复成为当前的热点问题。已报道的关闭盆底的技术主要有直接缝合和借助于自体或异体组织修复（大网膜或子宫填塞、肌皮瓣移植修复和生物补片修补等）。直接缝合的并发症发生率较高；而对白体或异体组织修复技术而苦，每种方法均有其自身的优势和缺点．公认的最佳修复技术目前尚不明确。一项对比生物补片和臀大肌皮瓣修复盆底的综述指出，两种技术的术后并发症相似，但生物补片修复技术的住院时间明显缩短，住院花费减少，故推荐采片j生物补片修复盆底。今后的发展方向可能是组合使用几种技术来提高盆底修复的成功率和降低术后并发症发生卒，最佳的单一或组合技术尚需大样本的对照研究来证实。Extralevator abdominoperineal excision （ELAPE） has been described to improve the outcomes of advanced low rectal cancer, probably because of more pelvic dissection and less positive circumferential reseetion margin （CRM）. Recent improvements of ELAPE have focused on the reconstruction of the large pelvic defect. Different approaches have been focused on the reconstruction including primary closure, uterus retroversion, omentoplasty, myocutaneous flaps, and biological mesh. The optimal method is still controversial. Recent reviews showed that the perineal wound complications of biological mesh reconstruction were comparable to those of myocutaneous flaps. Moreover reviews suggested the use of biologic materials to close the perineal defect because it offers a significant cost saving mostly attributable to reduction in hospital length of stay. The combination of different techniques may be tile best way to reconstruct the pelvic defect following ELAPE.

关 键 词：直肠肿瘤 肛提肌外腹会阴联合切除术 盆底缺损 盆底修复 

分 类 号：R735.37[医药卫生—肿瘤]