腹腔镜下肛提肌外腹会阴联合切除与腹会阴联合切除术的比较  

Extralevator abdominal perineal excision and abdominal perineal resection

作　　者：徐溢新[1] 刘佳[1] 宋虎[1] 许腾[1] 符炜[1] 徐为[1] 宋军[1] 

机构地区：[1]徐州医学院附属医院胃肠外科,221000

出　　处：《中华普外科手术学杂志（电子版）》2015年第6期64-66,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：江苏省卫生厅面上项目(H201220);江苏省"六大人才高峰"项目(2012-WS-068);徐州市科技发展基金资助项目(KC134SH103);江苏省第四期"333高层次人才培养工程"项目~~

摘　　要：目的比较改良腹腔镜下肛提肌外腹会阴联合切除术（IELAPE）与经腹会阴联合直肠癌切除术（APE）治疗低位直肠癌的安全性和短期手术效果。方法回顾性分析2011年1月至2014年12月收治的72例因末段直肠癌行手术治疗的患者临床资料。46例患者接受APE（APE组）,26例患者接受IELAPE（IELAPE组）。采用SPSS16.0软件行统计学分析,术中、术后计量数据以±s表示,使用独立样本t检验;会阴部切口感染发生率、术中标本穿孔率比较使用检验,以P〈0.05为差异有统计学意义。结果 IELAPE组患者较传统APE组术中出血量减少[（119.6±26.7）ml比（220.7±21.8）ml,t=4.752],手术时间短[（176.1±32.5）min比（214.6±58.7）min,t=6.304],术中穿孔率低[（3.85%）比（8.70%）,χ~2=4.891],术后排气时间缩短[（2.5±1.7）d比（4.7±2.6）d,t=4.379],差异均有统计学意义（P〈0.05）。会阴引流拔出时间、会阴切口感染发生率、淋巴结获取数目差异均无统计学意义。经过短期随访,术后无肠管膨出和盆底疝发生,无局部复发及远处转移,至今无死亡病例。结论相较于经典APE手术,IELAPE术中出血量较少,手术时间较短,术中穿孔率较低,术后排气时间恢复较快,手术安全性高,短期疗效良好。Objective To investigate the safety and efficacy of both improved extrale vator abdominoperineal excision（ IEl APE） and traditional abdominoperineal excision（ APE） in patients with low rectal cancer. Methods We retrospectively analyzed the clinical data of 72 patients with distal rectal cancer who had been treated in our hospital from Junary 2011 to December 2014. Fourty-six patients were treated with APE,and26 patients were treated with IELAPE,and the clinical effect and safety of the operations were compared between the two groups. All the data were analyzed by statistical software SPSS16. 0. The intraoperative and postoperative data of the two groups were expressed as mean ± SD and analyzed with Student＇s t test. The incidence of perineal incision infection,and specimen perforation rate were compared by independent test. P〈0. 05 was considered statistically significant. Results Compared with the traditional APE group,the IEl APE group demonstrated less intraoperative blood loss [（ 119. 6 ± 26. 7） ml vs.（ 220. 7 ± 21. 8） ml,t = 4. 752],shorter operation time[（ 176.1 ±32.5） min vs.（ 214. 6 ± 58. 7） min,t = 6. 304],lower incidence rate of intraoperative perforation（ 3.85%vs. 8.70%,χ~2= 4. 891）,shorter exhaust time [（ 2. 5 ± 1. 7） d vs.（ 4. 7 ± 2. 6） d,t = 4. 379]. There was no significant difference in the incidence of infection and the number of lymph nodes during the perineal drainage between the two groups（ P〈0. 05）. After a short period of follow-up,there were neither postoperative intestinal prolapse and pelvic floor hernia nor local recurrence,distant metastasis,deaths. Conclusions IELAPE is better than traditional APE in less intraoperative blood loss, shorter operation time, lower intraoperative perforation,shorter exhaust time and earlier ambulation.

关 键 词：直肠肿瘤 腹腔镜检查 

分 类 号：R735.37[医药卫生—肿瘤]