CAJ | 학술논문

目的介绍直肠癌柱状经腹会阴切除术(cylindrical abdominoperineal resection,CAPR)的应用体会.方法 2009-2010年采用柱状经腹会阴直肠癌切除术治疗低位直肠癌15例.采用Holm等描述的手术方法.按TME技术要求游离直肠系膜,向下游离至肛提肌的起点处,结肠造口,关闭腹部切口.将患者置于俯卧位,实施扩大的会阴部切除,沿外括约肌、耻骨直肠肌、肛提肌外表面游离至肛提肌的盆壁起始处,即腹部向下游离的终点下方,后方自尾骨骶骨连接处切开,进入骶前,由背侧至腹侧,将肛提肌自起始处离断.结果柱状经腹会阴切除术切除更多远端直肠周围组织,15例均无直肠穿孔,会阴切口均Ⅰ期愈合,1例发生会阴血肿,1例发生盆底腹膜疝,1例发生下肢深静脉血栓形成;术后平均随访6个月,1例发生盆腔腹膜后淋巴结转移,1例发生肝肺转移.结论柱状经腹会阴切除术可以切除更多的低位直肠癌周组织,有利于减少术中穿孔发生率和环周切缘阳性率,进一步降低术后局部复发率.
목적 개소직장암주상경복회음절제술(cylindrical abdominoperineal resection,CAPR)적응용체회.방법 2009-2010년채용주상경복회음직장암절제술치료저위직장암15례.채용Holm등묘술적수술방법.안TME기술요구유리직장계막,향하유리지항제기적기점처,결장조구,관폐복부절구.장환자치우부와위,실시확대적회음부절제,연외괄약기、치골직장기、항제기외표면유리지항제기적분벽기시처,즉복부향하유리적종점하방,후방자미골저골련접처절개,진입저전,유배측지복측,장항제기자기시처리단.결과 주상경복회음절제술절제경다원단직장주위조직,15례균무직장천공,회음절구균Ⅰ기유합,1례발생회음혈종,1례발생분저복막산,1례발생하지심정맥혈전형성;술후평균수방6개월,1례발생분강복막후림파결전이,1례발생간폐전이.결론 주상경복회음절제술가이절제경다적저위직장암주조직,유리우감소술중천공발생솔화배주절연양성솔,진일보강저술후국부복발솔.
Objective To decrease tumor local recurrence after abdominoperineal resection (APR)for low rectal cancer using cylindrical abdominoperineal resection. Methods From February 2009 to February 2010 cylindrical APR was performed in 15 patients of advanced ultralow rectal cancer at the Department of General Surgery, Qilu Hospital of Shandong University, according to the standard protocol as described by Holm. The procedure involves careful mobilization of the mesorectum as far down as the origins of the levator muscle. Ater stoma formation, the abdomen is closed, the patient is rotated into the prone position, and an extended perineal dissection is performed. This includes the sphincter complex and the inferior surface of the levators to a point laterally where they originate on the pelvic sidewall. This point should be just inferior to the level where the abdominal procedure was terminated. The coccyx is often removed in continuity with the main specimen to improve direct visualization of the dissection.Results The cylindrical technique removed more tissue in the distal rectum. There was no bowel perforation, perineal wounds were primary healing. One patient developed perineal seroma. One patient developed peritoneocele hernia of pelvic floor. Conclusions Cylindrical APR performed in the prone position for low rectal cancer removes more tissue around the tumor that leads to a reduction in intraoperative perforations, which should reduce local disease recurrence.