肛提肌外腹会阴联合切除术治疗低位直肠癌对预防肿瘤局部复发的意义  

Clinical significance of extralevator abdominoperineal excision in preventing local recurrence of low rectal cancer

作　　者：李铮宇 陈超群 陈嵩 邝永龙 朱富达 黄俊明 

机构地区：[1]台山人民医院,广东台山529200

出　　处：《广州医科大学学报》2016年第2期55-58,共4页Academic Journal of Guangzhou Medical University

摘　　要：目的:探讨肛提肌外腹会阴联合切除术治疗低位直肠癌预防肿瘤局部复发的临床效果。方法:回顾性分析2011年01月至2014年01月我院行手术治疗的低位直肠癌患者临床病历资料,按照手术方式分为肛提肌外腹会阴联合切除术(观察组)和传统经腹会阴联合直肠癌切除术(对照组),比较两组患者的近期临床疗效和术后1年、2年局部肿瘤复发率。结果:两组手术时间、术中出血量、骶前引流管引流时间以及住院时间比较,差异无统计学意义(P>0.05)。观察组术中穿孔率、术后环周切缘阳性率低于对照组,会阴部切口延迟愈合、切口感染发生率高于对照组,差异有统计学意义(P<0.05),两组术后肠梗阻、泌尿生殖系统障碍、会阴部慢性疼痛发生率差异无统计学意义(P>0.05)。术后平均随访时间(1.5±0.7)年,观察组1年、2年局部肿瘤复发率为9.09%、28.26%,分别低于对照组的21.21%、43.48%,差异有统计学意义(P<0.05)。结论:肛提肌外腹会阴联合切除术治疗低位直肠癌的近期疗效好,安全性高,可明显降低术后1年、2年局部肿瘤复发率。Objective：To investigate the clinical significance of extralevator abdominoperineal excision （ ELAPE） in preventing local recurrence of low rectal cancer. Methods：A retrospective analysis was performed on medical charts of patients who underwent surgical treatment of low rectal cancer in our hospital between January 2011 and January 2014. According to surgical options,the subjects received ELAPE （ study group） or conventional transabdominal perineal resection of rectal cancer （ control group） . The short-term clinical efficacy, 1-year and 2-year local recurrence rates were compared between the two groups. Results： The operation time, blood loss,indwelling time of presacral drainage,and hospital stay were not statistically different between groups （P〉0.05）. Compared with the control group,the study group had lower rates of intraoperative perforation and positive circumferential resection margin,and higher rates of delayed wound healing and infection of the perineal incision, with statistically significant difference between groups （ P〈0. 05 ） . There were no differences in postoperative ileus,urinary and reproductive disorders,and chronic perineal pain between the two groups （P〉0.05）. The mean follow-up duration after surgery was （1.5±0.7） years. The 1-and 2-year local recurrence rates were 9.09% and 28. 26% in the study group, which was lower that 21. 21% and 43. 48%, respectively, in the control group with statistically significant difference （ P〈 0. 05 ） . Conclusion： Extralevator abdominoperineal excision provides satisfactory short-term efficacy and good safety for treatment of low rectal cancer, and is associated with significantly lower rates of local recurrence at 1 and 2 years postoperatively.

关 键 词：肛提肌外腹会阴联合切除术 低位直肠癌 局部肿瘤复发 

分 类 号：R735.3[医药卫生—肿瘤]