腹腔镜下经肛提肌外腹会阴联合切除术治疗低位进展期直肠癌46例  

Experiences of Laparoscopic Extralevator Abdominoperineal Excision for 46 Cases of Advanced Low Rectal Cancer

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

机构地区：[1]徐州医学院附属医院胃肠外科,江苏徐州221002

出　　处：《中国普外基础与临床杂志》2016年第2期218-220,共3页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结采用腹腔镜下经肛提肌外腹会阴联合切除(ELAPE)治疗低位进展期直肠癌的应用体会。方法回顾性分析徐州医学院附属医院胃肠外科2012年1月至2015年5月期间采用腹腔镜下ELAPE术治疗的46例进展期低位直肠癌患者的临床资料。会阴部操作采用俯卧折刀位,术中根据肿瘤侵犯肛提肌程度,个体化切除肛提肌范围,会阴部切口缝合皮下和皮肤,腹腔镜下缝合盆底腹膜。分析术中、术后和随访的各项指标。结果46例均顺利完成手术,无术中并发症、腹腔镜相关并发症及中转手术。手术时间(175.3±26.5)min,术中出血量(55.7±28.6)m L,获取淋巴结(16.3±7.7)枚。所有标本上的肛提肌均附着在直肠系膜上,肠管断端及侧切缘均阴性。结论腹腔镜下ELAPE术可以切除更多的肿瘤周围组织,降低环周切缘阳性率,减少术中肠穿孔的发生,降低局部复发。同时腹腔镜直视下的操作有暴露良好、解剖精细等优点,个性化切除肛提肌可进一步减少并发症的发生。Objective To summarize experiences of laparoscopic extralevator abdominoperineal excision（ELAPE） in treatment of advanced low rectal cancer. Methods The clinical data of 46 patients with advanced low rectal cancer underwent laparoscopic ELAPE in our center from January 2012 to May 2015 were retrospectively analyzed. During the procedures, the anus and its surrounding tissue were individually resected by perineal approach with jackknife position. The pelvic perinium was closed laparoscopically. The operation time, intraoperative blood loss, retrieval of lymph nodes, radial margin, and postoperative complications were recorded. Results The procedures were successfully performed without any intraoperative complications, complications associated with laparoscopy, or conversion to the open approach. The operation time was（175.3±26.5） min. The intraoperative blood loss was（55.7±28.6） m L. The number of lymph node retrieval was 16.3±7.7. No positive radial margin was identified. Conclusion Sufficient resection of circumferential tissue, lower intraoperative perforation rate and satisfactory circumferential margin-negative rate could be achieved by laparoscopic ELAPE in treatment of advanced low rectal cancer.

关 键 词：低位直肠癌 腹腔镜 肛提肌外腹会阴切除术 

分 类 号：R735.37[医药卫生—肿瘤]