肛提肌外腹会阴联合切除术  

Extralevator abdominoperineal excision

作　　者：叶颖江[1] 

机构地区：[1]北京大学人民医院胃肠外科,100044

出　　处：《中华普外科手术学杂志（电子版）》2015年第3期25-25,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：北京市科技计划项目(Z121100005312015);首都卫生发展科研专项项目(2011-4022-05);首都临床特色应用研究项目(Z111107058811046)~~

摘　　要：肛提肌外腹会阴联合切除术(ELAPE)先经腹部途径进行,直肠游离下界,后方至骶尾关节处,侧方至自主神经下方,前方分离到精囊腺(男性)下方或宫颈(女性)水平。患者采取俯卧折刀位进行会阴部操作,首先在肛门外括约肌外侧的肛周皮肤做梭型切口,上方达骶5水平,下方至会阴处。会阴部游离沿着肛提肌和外括约肌外侧平面游离,至靠近盆壁的起点处。尾骨可根据显露需要去除。皮下组织以2-0可吸收线缝合,皮肤以2-0滑线缝合。This procedure was initially performed via an abdominal approach. Mesorectal mobilization stopped posteriorly at the upper border of the coccyx, laterally below the autonomic nerves, and anteriorly below the vesicles in men and cervix in women. The patient was turned to a prone （jack-knife） position for the perineal phase. A ＂ spindle like＂ perianal incision was made at the lateral border of the external anal sphincter, the upper wound reached the level of S5, and the lower wound was at the level of the perineum. The dissection was continued along the outer plane of the levator and external anal sphincter to the insertion of the levator muscles on the pelvic side wall. The coccyx was disarticulated as needed for access. The subcutaneous perineum wound was closed directly by 2 - 0 absorbable sutures, and the perineal skin was sutured using 2 -0 slide sutures directly.

关 键 词：直肠肿瘤 消化系统外科手术 

分 类 号：R657.1[医药卫生—外科学]