肛提肌外腹会阴联合切除术与传统腹会阴联合切除术治疗低位直肠癌的对比研究  

Extralevator abdominoperineal excision versus traditional abdominoperineal excision in the treatment of low rectal cancer

作　　者：张鑫[1] 申占龙[2] 谢启伟[2] 尹慕军[2] 杨晓东[2] 姜可伟[2] 王有利[2] 曹键[2] 叶颖江[2] 王杉[2] 梁斌[2] 

机构地区：[1]北京大学人民医院外科肿瘤实验室,100044 [2]北京大学人民医院胃肠外科,100044

出　　处：《中华胃肠外科杂志》2014年第11期1106-1110,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 比较肛提肌外腹会阴联合切除术（ELAPE）与传统腹会阴联合切除术（APE）治疗低位直肠癌的安全性和手术效果.方法 回顾性分析北京大学人民医院胃肠外科2011年1月至2013年12月间接受腹会阴联合切除手术治疗的61例低位直肠癌患者的临床资料,按手术方式分为ELAPE组（33例）和传统APE组（28例）,比较两组的手术安全性和手术效果.结果 ELAPE组患者较传统APE组术中出血量减少[（201±147） ml比（343±308） ml,P=0.022]、术后排气时间缩短[（3.8±1.5）d比（4.6±1.6）d,P=0.039）]、会阴伤口并发症发生率降低[9.1％（3/33）比25.0％（7/28）,P=0.042],但手术时间[（292±46） min比（256±28） min）]和会阴引流拔除时间[（1 1.1±4.8）d比（7.1±2.7）d]延长（均P＜0.01）.ELAPE组与传统APE组患者淋巴结清扫数和阳性淋巴结数差异无统计学意义（均P＞0.05）.ELAPE组患者术中穿孔率（6.1％）低于传统APE组（17.9％）,但差异无统计学意义（P＞0.05）.两组术后排粪时间、恢复进食时间、会阴平均引流量、住院时间和会阴伤口拆线时间比较,差异均无统计学意义（均P＞0.05）.结论 相较于传统APE手术,ELAPE手术术中出血量较少,会阴伤口并发症较低,术中穿孔率较低.ELAPE手术安全性较好,术后短期疗效良好。Objective To compare the safety and efficacy between extralevator abdominoperineal excision （ELAPE） and traditional abdominoperineal excision （APE） in patients with low rectal cancer.Methods From January 2011 to December 2013,61 patients undergoing abdominoperineal excision for low rectal cancer at the Department of Gastrointestinal Surgery,Peking University People＆#39;s Hospital were enrolled.The safety and efficacy of two procedure groups,ELAPE group （33 patients） and traditional APE group（28 patients） were reviewed retrospectively.Results Less intraoperative blood loss [（201±147） ml vs.（343±308） ml,P=0.022],shorter exhaust time [（3.8±1.5） d vs.（4.6±1.6） d,P=0.039] and lower perineal wound complication rate（9.1% vs.25.0%,P=0.042） were observed in the ELAPE group as compared to the traditional APE group.However,longer operation time [（292±46） min vs.（256±28） min,P=0.008] and perineal drainage removal time [（11.1t4.8） d vs.（7.1±2.7） d,P〈0.01] were noted in the ELAPE group than those in the traditional APE group.Number of lymph node retrieved and positive lymph node retrieved was not significantly different between two groups.The ELAPE group had lower rate of IOP （intraoperative perforation）（6.1% vs.17.9%,P=0.055）,but no significant difference was found.There were no significant differences in bowel movement,diet restoring time,average perineal drainage,postoperative hospitalization time and removing perineal stitches time between the two groups （all P〉0.05）.Conclusion ELAPE possesses less intraoperative blood loss and lower perineal wound complication rate than traditional APE.ELAPE is associated with better safety and efficacy than traditional APE.

关 键 词：直肠肿瘤 肛提肌外腹会阴联合切除术 传统腹会阴联合切除术 

分 类 号：R735.37[医药卫生—肿瘤]