CAJ | 학술논문

目的评估术中不更换体位腹腔镜下经肛提肌外腹会阴联合直肠癌切除术(ELAPE)的可行性.方法回顾性分析2011年9月至2014年4月北京协和医院基本外科收治的51例因末段直肠癌行腹腔镜下腹会阴联合切除患者的临床资料.其中男性29例,女性22例;平均年龄(61±10)岁.27例患者接受腹腔镜传统腹会阴联合切除术(APE)(APE组),24例接受ELAPE(ELAPE组).分别采用t检验和x2检验分析两组在一般病例特征、手术时间、侧切缘、术后并发症等方面是否存在差异.结果两组患者在一般病例特征、接受新辅助治疗情况等方面无差异(P值均＞0.05),ELAPE组手术时间低于APE组[(181±41) min比(228±58) min,t=-3.265,P=0.002],ELAPE组出血量更少{50(80)ml比80(100) ml[M(QR)],Z=-2.259,P=0.024},两组的淋巴结获取数目无差异[(17±8)枚比(15±7)枚,P =0.227].两组在侧切缘阳性、术后并发症、会阴切口愈合等方面均未发现差异(P值均＞0.05).结论从围手术期的短期疗效分析,术中不更换体位腹腔镜下完成ELAPE,一些手术步骤可以同步进行,节省了手术时间,近期肿瘤学疗效和术后并发症发生情况与传统APE类似.
목적 평고술중불경환체위복강경하경항제기외복회음연합직장암절제술(ELAPE)적가행성.방법 회고성분석2011년9월지2014년4월북경협화의원기본외과수치적51례인말단직장암행복강경하복회음연합절제환자적림상자료.기중남성29례,녀성22례;평균년령(61±10)세.27례환자접수복강경전통복회음연합절제술(APE)(APE조),24례접수ELAPE(ELAPE조).분별채용t검험화x2검험분석량조재일반병례특정、수술시간、측절연、술후병발증등방면시부존재차이.결과 량조환자재일반병례특정、접수신보조치료정황등방면무차이(P치균＞0.05),ELAPE조수술시간저우APE조[(181±41) min비(228±58) min,t=-3.265,P=0.002],ELAPE조출혈량경소{50(80)ml비80(100) ml[M(QR)],Z=-2.259,P=0.024},량조적림파결획취수목무차이[(17±8)매비(15±7)매,P =0.227].량조재측절연양성、술후병발증、회음절구유합등방면균미발현차이(P치균＞0.05).결론 종위수술기적단기료효분석,술중불경환체위복강경하완성ELAPE,일사수술보취가이동보진행,절성료수술시간,근기종류학료효화술후병발증발생정황여전통APE유사.
Objective To evaluate the short-term outcomes of laparoscopic extralevator abdominoperineal excision (ELAPE) without changing position during operation.Methods Totally 51 patients with distal advanced rectal cancer received surgical operation in Peking Union Midical College Hospital from September 2011 to April 2014.There were 29 male and 22 female patients with a mean age of (61 ± 10) years.Twenty-six percent of the patients received preoperative concomitant chemotherapy and radiation.Twenty-seven patients underwent laparoscopic abdominoperineal excision (APE) procedure,while 24 patients underwent ELAPE procedure.In both groups,patients were kept Lithotomy-Trendelenburg position during operation.The fat tissue in ischialrectal fossa was not routinely removed,except the tumor invasion.All the patients' pelvic peritoneum was closed by continuous suturing,and subcutaneous tissue and skin by interrupted suturing.Retrospectively compare the pathoclinical features,operation time,bleeding,node retrieval,lateral margin and complications by t-text and x2 test respectively between ELAPE and APE procedures both by laparoscopic approach.Results No significant differences were found in term of age,gender,BMI,distance from anal verge,percentage of neoadjuvant chemoradiation,and TNM staging between these two groups (all P ＞ 0.05).The operation time was significantly shorter in ELAPE group ((181 ±41) minutes vs.(228 ±58) minutes,t =-3.265,P =0.002).The bleeding volume was less in ELAPEE group (50 (80) ml vs 80(100)ml (M(QR)),Z=-2.259,P=0.024).The lateral margin,urinal retention and perineal wound healing were comparable for these two groups.No pelvic hernia was found during the postoperative follow-up (2 to 34 months) in both groups (all P ＞ 0.05).Conclusions Laparoscopic extralevator abdominoperineal excision without changing position is feasible for distal rectal cancer.Some essential steps can be simultaneously accomplished during operation without changing position.Closing the pelvic peritoneum is important for preventing the intestine dropping from abdominal cavity to presacral cavity.