腹腔镜经腹会阴直肠柱状切除术对直肠癌环周切缘状态影响的研究  

The Influence For The Status of Circumferential Resection Margin of Laparoscopic Cylindrical-Abdominperineal Resection

作　　者：李德钢[1] 庞黎明[1] 黄小明[1] 黄世佳[1] 李裕波[1] 吴卫[1] 黄深[1] 

机构地区：[1]广西中医药大学第一附属医院外二科,广西南宁530023

出　　处：《结直肠肛门外科》2014年第2期117-121,共5页Journal of Colorectal & Anal Surgery

摘　　要：目的探讨腹腔镜经腹会阴联合直肠柱状切除术(cylindrical abdominopedneal resection,CAPR)对直肠癌环周切缘(circumferential resection margin,CRM)状态的影响。方法回顾性分析2009年1月至2013年6月收治的47例低位直肠癌患者的病理及临床资料,其中27例患者行传统经腹会阴联合直肠癌切除术(abdominopedneal resection,APR),20例患者行CAPR手术,比较CRM与临床病理特征之间的关系。结果 CRM总体阳性率为25.3%(12/47)。其中,肿瘤直径≥5cm组CRM阳性率(36.7%,10/17)明显高于肿瘤直径<5cm组(5.9%,2/18)(χ2=4.417,P=0.036);在肿瘤分化程度方面,高分化组(11.1%,2/18)、中分化组(16.7%,2/12)、低分化组(47.1%,8/17)之间的CRM阳性率差异具有统计学意义(χ2=6.608,P=0.037);肿瘤下缘距肛缘距离≤3cm组CRM阳性率(38.5%,10/26)明显高于距离>3cm组(9.5%,2/21)(χ2=5.116,P=0.024)。CAPR手术明显比APR手术具有较低的CRM阳性率[10%(2/20)v 37%(10/27);χ2=4.416,P=0.036]和直肠穿孔率[0(0/20)v 25.9%(7/27);χ2=2.219,P=0.04]。结论与APR手术相比,CAPR手术能降低CRM阳性率和术中直肠穿孔率。Objective To investigate the method of laparoscopic cylindrical abdominoperineal resection （CAPR） for low rectal cancer, and to investigate it＇s influence for the status of circumferential resection margin （CRM）. Methods The pathological and clinical datas of 47 patients with low rectal carcinoma from January 2009 to June 2013 were collected. Twenty-seven patients undergoing abdominoperineal resection {APR） and twenty patients undergoing CAPR were analyzed retrospectively. The relationships between CRM and clinicopathologic characteristics were evaluated. Results The positive rate of CRM was 25.3% （12/47）. Respectively , the group of tumor diameter ≥ 5 cm （36.7%, 10/17） was significantly higher than the group of tumor diameter 〈5 cm （5.9%, 2/18） （χ2=4. 417, P -=0. o36）. The differences among well-differentiated group （11.1%, 2/18）, moderately differentiated group （16.7%, 2/12）, and poorly differentiated group （ 47.1%, 8/17 ） were statistically significant （ χ2=6. 608, P = 0. 037 ）. The positive rate of CRM in the tumors with a distance of less than 3cm between the anal verge and the lower tumor margin was significantly higher than that in tumors with the above-mentioned distances of greater than or equal to 5 cm （9.5%, 2/21） （χ2=5.116, P =0.024}. The lower positive rate of CRM [10% （2/20） vs 37 % （10/27 ） ; χ2= 4. 416, P = 0. 036] and lower rate of rectal perforation [＇0 （0/20） vs 25.9 % （ 7/27 ） ;χ2=2. 219, P=0. 04] in the CAPR group were significantly higher than those in the APR group. Conclusion Compared with the APR surgery, the CAPR surgery could reduce CRM positive rate and the rectal perfo- ration rate.

关 键 词：直肠肿瘤 环周切缘 经腹会阴柱状切除术 

分 类 号：R735.37[医药卫生—肿瘤]