CAJ | 학술논문

肛提肌外腹会阴联合直肠切除术（ELAPE）是近年来提出的治疗低位进展期直肠癌的重要术式。由于ELAPE 切除了更多的肿瘤周围组织，从而降低了环周切缘阳性率、肿瘤穿孔率和局部复发率，进一步提高了患者的生存率。但其形成的盆底巨大缺损增加了会阴伤口相关的并发症，因此，ELAPE术后盆底巨大缺损的修复成为当前的热点问题。已报道的关闭盆底的技术主要有直接缝合和借助于自体或异体组织修复（大网膜或子宫填塞、肌皮瓣移植修复和生物补片修补等）。直接缝合的并发症发生率较高；而对自体或异体组织修复技术而言，每种方法均有其自身的优势和缺点，公认的最佳修复技术目前尚不明确。一项对比生物补片和臀大肌皮瓣修复盆底的综述指出，两种技术的术后并发症相似，但生物补片修复技术的住院时间明显缩短，住院花费减少，故推荐采用生物补片修复盆底。今后的发展方向可能是组合使用几种技术来提高盆底修复的成功率和降低术后并发症发生率，最佳的单一或组合技术尚需大样本的对照研究来证实。
항제기외복회음연합직장절제술（ELAPE）시근년래제출적치료저위진전기직장암적중요술식。유우ELAPE 절제료경다적종류주위조직，종이강저료배주절연양성솔、종류천공솔화국부복발솔，진일보제고료환자적생존솔。단기형성적분저거대결손증가료회음상구상관적병발증，인차，ELAPE술후분저거대결손적수복성위당전적열점문제。이보도적관폐분저적기술주요유직접봉합화차조우자체혹이체조직수복（대망막혹자궁전새、기피판이식수복화생물보편수보등）。직접봉합적병발증발생솔교고；이대자체혹이체조직수복기술이언，매충방법균유기자신적우세화결점，공인적최가수복기술목전상불명학。일항대비생물보편화둔대기피판수복분저적종술지출，량충기술적술후병발증상사，단생물보편수복기술적주원시간명현축단，주원화비감소，고추천채용생물보편수복분저。금후적발전방향가능시조합사용궤충기술래제고분저수복적성공솔화강저술후병발증발생솔，최가적단일혹조합기술상수대양본적대조연구래증실。
Extralevator abdominoperineal excision (ELAPE) has been described to improve the outcomes of advanced low rectal cancer, probably because of more pelvic dissection and less positive circumferential resection margin (CRM). Recent improvements of ELAPE have focused on the reconstruction of the large pelvic defect. Different approaches have been focused on the reconstruction including primary closure, uterus retroversion, omentoplasty, myocutaneous flaps, and biological mesh. The optimal method is still controversial. Recent reviews showed that the perineal wound complications of biological mesh reconstruction were comparable to those of myocutaneous flaps. Moreover reviews suggested the use of biologic materials to close the perineal defect because it offers a significant cost saving mostly attributable to reduction in hospital length of stay. The combination of different techniques may be the best way to reconstruct the pelvic defect following ELAPE.