腹会阴联合切除术历史回顾及现状  

Abdominoperineal resection: Historical review and present situation

作　　者：王林[1,2] 顾晋[1,2] 

机构地区：[1]北京大学肿瘤医院结直肠肿瘤外科 [2]北京市肿瘤防治研究所 恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国实用外科杂志》2014年第9期812-816,共5页Chinese Journal of Practical Surgery

摘　　要：腹会阴联合切除术(abdominoperineal resection,APR)是低位直肠、肛管恶性肿瘤的标准术式。APR手术范围通常包括肛提肌、坐骨直肠窝脂肪和会阴皮肤,最主要的目的和原则是获得阴性的环周切缘。交界性保肛的病人应进行高质量的MRI评价,进行充分的术前计划,避免术中决策。近年来众多研究重新强调了肛提肌切除范围的重要性。对这种手术技巧的回顾以及重命名,如柱状APR或肛提肌外腹会阴联合切除术(ELAPE),使APR手术质量得到提高。APR可根据切除范围分为3类:(1)肛提肌内APR,即"传统"或"标准"APR;(2)ELAPE、柱状APR;(3)Miles APR、坐骨直肠窝切除APR。在高选择的病例中,APR联合多脏器切除,如精囊腺切除、阴道后壁切除等,有利于提高R0切除率,同时兼顾器官功能的保留。Abdominoperineal resection（APR） is the procedure of choice for treatment of rectal adenocarcinomas arising in the distal rectum or anal canal. APR involve sremoval of the entire rectum, mesorectum, anal canal, levator muscle, and portions of the ischiorectal fat and perineal skin.The aim of APR is to obtain negative circumferential resection margins（CRM）. Surgical dissection for an APR candidate should be planned preoperatively by high-quality imaging and thorough physical examination. It must be accomplished with strict attention to tumor size and location, circumferential margin, distal margin, and invasion of the levator muscle and adjacent organs. Recent publications have emphasized the importance of resecting the levator muscles in continuity with the distal rectum. The re-visitation of the surgical planes, as described in the original Miles procedure, is now often referred to as＂cylindrical APR＂or＂extra-levator APR, ELAPE＂, asopposed to ＂conventional＂ or ＂standard＂ APR. Three variations of standard APR can be described based on plane of dissection in the perineal phase： 1. Intra-levator APR, which is equivalent to the conventional APR described in the last decade; 2.Extra-levator APR, which is equivalent to the cylindrical or extra-levator APR; 3.Ischiorectal APR, which is with wide perineal resection and equivalent to the original Miles APR described in the early 20 th century. In selected cases, an APR with multi-visceral resection—such as seminal vesiculectomy or prostatectomy in male patients, or partial vaginectomy in female patients—can preserve urinary function without compromising the principles of en-bloc R0 resection.

关 键 词：腹会阴联合切除术 肛提肌 分类 环周切缘 

分 类 号：R6[医药卫生—外科学]