肛提肌外腹会阴联合切除术(ELAPE)治疗低位直肠恶性肿瘤的临床体会  

Clinical Experience on Extra-levator Abdominoperineal Excision for Low Malignant Rectal Neoplasms

作　　者：刘洋[1,2] 袁联文[1] 周建平[1] 刘栋才[1] 舒国顺[1] 周家鹏[1] 

机构地区：[1]中南大学湘雅二医院老年外科,长沙410011 [2]湖南省祁阳县人民医院胃肠外科,祁阳426100

出　　处：《中国现代手术学杂志》2014年第6期401-404,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨肛提肌外腹会阴联合切除术（extra-levator abdominalperineal excision,ELAPE）在低位直肠癌非保肛手术中的应用价值。方法回顾性分析2012年3月～2014年4月间在我科行ELAPE的11例低位直肠恶性肿瘤患者的临床资料,肿瘤下缘距肛缘0～5 cm。结果本组患者手术时间平均为3.6（3～4）h,术中无直肠穿孔的发生,无围手术期死亡病例。标本游离并切除后呈圆柱状,由肛管、中下段直肠及直肠系膜、大部分肛提肌等组织构成,并有较多的组织结构覆盖在病变组织表面。病理检查结果示所有11例患者切除标本CRM阳性率为0。术后拔除骶前引流管时间平均为7（5～10）d。术后发生尿潴留2例（18.2%）,予对症治疗后好转。行补片修补会阴部缺损的3例患者中,术后发生会阴部伤口感染1例（9.1%）,遂行补片取出术,会阴部伤口积极换药,持续负压冲洗引流,伤口逐渐愈合。余均未发生会阴部并发症,术后第10～14 d出院。结论 ELAPE是一种全新、安全的低位直肠恶性肿瘤根治术,能明显减少术中肠穿孔发生率,降低CRM阳性率,从而降低肿瘤的局部复发率和远处转移率,并且可以减少会阴部切口并发症的发生率,提高患者的生活质量和生存率,具有重要的临床应用价值。Objective To evaluate the value of extra levator abdominoperineal excision （ELAPE） in the non-anus saving surgery for low malignant rectal neoplasms. Methods The clinical data of eleven patients suffered low malignant rectal neoplasms treated by ELAPE from March 2012 to April 2014 in our department were analyzed retrospectively. The distance between lower edge of tumor and anal sphincter ranged from 0 to 5 cm. Results The operative duration ranged from 3 to 4 hours with an average of 3.6 hours. Neither intra-operative rectal perforation nor perioperative death was found. The excisional specimen showed circular cylinder shape and included anal canal, mid-inferior segment rectum, mesorectum and main levator ani muscle. The positive rate of circumferential resection margin （CRM） was 0 in all 11 cases. The extubation time of pre- sacral drainage tube was 5 to 10 days（mean 7 days） after the surgery. Urinary retention was found in 2 cases （ 18.2% ） and improved by symptomatic treatment. Wound infection of perineal position was found in one case （9.1%） received patch repair of ano-genital defect, and cured by reoperation of patch-out, change dressing of ano-genital infection and continuous negative pressure drainage. Conclusions ELAPE is a new and safe sur- gical approach for low malignant rectal neoplasms. It could obviously reduce the incidence of intestinal perfora- tion, decrease the incidence of positive CRM, tumor local recurrence and distant metastasis rate, lessen the probability of the perineal incision delayed healing, and then it can improve the survival and the quality of life.

关 键 词：直肠肿瘤 肛提肌外腹会阴联合切除术 直肠穿孔 环周切缘 外科伤口感染 会阴 

分 类 号：R735.37[医药卫生—肿瘤]