CAJ | 학술논문

目的探讨个体化柱状腹会阴联合切除术(CAPR)治疗低位进展期直肠癌的安全性和可行性.方法 2011年6月至2012年2月11例低位进展期直肠癌患者接受个体化CAPR手术(个体化手术组),其中男性7例,女性4例,年龄32～74岁,中位年龄64岁；与2008年1月至2012年2月实施的47例经典CAPR(经典手术组)进行对比分析.比较两组患者的临床参数、病理学研究结果和术后并发症发生情况.结果个体化手术组病例中,保留或部分保留一侧肛提肌6例,保留骶尾骨3例,贴近直肠前壁解剖2例.与经典手术组相比,个体化手术组的标本水平切面总面积[(2197±501) mm2]和固有肌层外面积[(1722 ±414) mm2]较小,但差异无统计学意义(P =0.150、0.167);两组患者的手术时间、术中失血量、标本的环周切缘阳性率、肠管穿孔率差异均无统计学意义(P＞0.05).个体化手术组术后慢性会阴疼痛(2/11,x2=6.116,P=0.013)和性功能障碍(2/9,x2=4.412,P=0.036)的发生率明显降低.结论个体化CAPR的手术效果良好,在不影响手术根治性的前提下,可能会降低术后的慢性会阴疼痛和性功能障碍的发生.
목적 탐토개체화주상복회음연합절제술(CAPR)치료저위진전기직장암적안전성화가행성.방법 2011년6월지2012년2월11례저위진전기직장암환자접수개체화CAPR수술(개체화수술조),기중남성7례,녀성4례,년령32～74세,중위년령64세；여2008년1월지2012년2월실시적47례경전CAPR(경전수술조)진행대비분석.비교량조환자적림상삼수、병이학연구결과화술후병발증발생정황.결과 개체화수술조병례중,보류혹부분보류일측항제기6례,보류저미골3례,첩근직장전벽해부2례.여경전수술조상비,개체화수술조적표본수평절면총면적[(2197±501) mm2]화고유기층외면적[(1722 ±414) mm2]교소,단차이무통계학의의(P =0.150、0.167);량조환자적수술시간、술중실혈량、표본적배주절연양성솔、장관천공솔차이균무통계학의의(P＞0.05).개체화수술조술후만성회음동통(2/11,x2=6.116,P=0.013)화성공능장애(2/9,x2=4.412,P=0.036)적발생솔명현강저.결론 개체화CAPR적수술효과량호,재불영향수술근치성적전제하,가능회강저술후적만성회음동통화성공능장애적발생.
Objective To evaluate the safety and efficacy of individual cylindrical abdominoperineal resection (CAPR) for locally advanced low rectal cancer.Methods From June 2011 to February 2012,11 patients with locally advanced low rectal cancer underwent individual CAPR.There were 7 male and 4 female patients,aged from 32 to 74 years with a median of 64 years.Forty-seven patients underwent classic CAPR from January 2008 to February 2012.Preoperative and postoperative parameters such as clinical information of patients,tissue morphometry and complications were compared.Results In the individual surgical group,6 patients were treated with one side levator ani muscle totally or partially reserved,3 patients with sacrococcyx reserved,and 2 patients with dissection close to the anterior rectal wall.Compared with classical surgery,the individual surgical specimens of horizontal section area ((2197 ±501) mm2) and intrinsic muscle layer outer area ((1722 ±414) mm2) were small,but the difference was not statistically significant (P =0.150 and 0.167).The operative time,intraoperative blood loss,circumferential resection margin,total cross sectional tissue area,cross sectional tissue area outside the muscularis propria and bowel perforation rate between the two groups were not significantly different.Individual CAPR showed less incidence of chronic perineal pain (2/11,x2 =6.116,P =0.013) and sexual dysfunction (2/9,x2 =4.412,P =0.036) compared with classic CAPR.Conclusions Individual CAPR has the potential to reduce the risk of chronic perineal pain and sexual dysfunction without influencing the radical effect when compare with classic CAPR for the treatment of low rectal cancer.