协和医学杂志

2014, v.5(02) 152-157

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腹腔镜下经肛提肌外腹会阴联合直肠癌切除术的单中心经验
Laparoscopic Extralevator Abdominoperineal Excision: Experience from a Single Center

肖毅;邱辉忠;吴斌;牛备战;孙曦羽;张冠南;林国乐;
XIAO Yi;QIU Hui-zhong;WU Bin;NIU Bei-zhan;SUN Xi-yu;ZHANG Guan-nan;LIN Guo-le;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

目的探索腹腔镜下完成经肛提肌外腹会阴联合直肠癌切除(extralevator abdominoperineal excision,ELAPE)手术的可行性。方法回顾性分析本院2012年6月至2013年8月实施的12例腹腔镜下ELAPE手术的围手术期特点,手术过程中侧方完全切除肛提肌组,后方切除其在尾骨的附着点,前方根据肿瘤分期和位置决定是否行周围脏器的扩大切除。术中不更换体位,会阴切口缝合皮下和皮肤,缝闭盆底腹膜。从手术时间、术中出血、淋巴结获取数目、术后并发症等方面判断手术的可行性。结果患者平均年龄(65.2±12.5)岁,体重指数21.6±3.1;肿瘤下缘距肛缘(3.3±0.7)cm;手术时间(176.1±27.5)min,术中出血(49.6±38.2)ml;淋巴结获取数目(18.3±7.8)枚,所有肠管断端及侧切缘均阴性;2例发生尿潴留,9例患者会阴切口达到甲级愈合。结论据手术短期效果,术中不更换体位,根据个体情况选择性行周围脏器的扩大切除,在腹腔镜下完成ELAPE手术是可行的。
Objective To investigate the feasibility of extralevator abdominoperineal excision( ELAPE) under laparoscope. Methods We retrospectively analyzed 12 patients with distal rectal cancer who underwent ELAPE in our center from June 2012 to August 2013. During the procedures,the levator ani muscles were cut off laparoscopically at its origin at both sides on the pelvic wall,and its attachment on coccyx was removed posteriorly. The dissection plane was taken along the Denonvillier fascia anteriorly as far as possible to the perineal body. The adjacent organs were removed if invaded by the tumors. The anus and its surrounding tissue were removed by perineal approach without changing patients' positions. The pelvic perinium was closed laparoscopically to prevent the intestine dropping. The operation time,blood loss,retrieval of lymph nodes,radial margin,and postoperative complications were recorded. Results The patients aged( 65. 2 ± 12. 5) years and their body mass index was 21. 6 ± 3. 1. The distance from lower edge of tumor to anal verge was( 3. 3 ± 0. 7) cm. The procedure lasted( 176. 1 ±27. 5) minutes,with a blood loss of( 49. 6 ± 38. 2) ml. The average number of node retrieval was 18. 3 ± 7. 8,and no positive radial margin was identified. The postoperative complications included urinary retention in 2 patients. The perineal incision appeared to be class A healing in 9 patients. Conclusion By extensively removing the levator ani muscles laterally and posteriorly,ELAPE procedure can be accomplished under laparo-scope without changing operative position or flap repair of the pelvic floor.

关键词(KeyWords): 直肠癌,手术;腹腔镜;肛提肌
rectal cancer,operation;laparoscope;levator ani muscle

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作者(Author): 肖毅;邱辉忠;吴斌;牛备战;孙曦羽;张冠南;林国乐;
XIAO Yi;QIU Hui-zhong;WU Bin;NIU Bei-zhan;SUN Xi-yu;ZHANG Guan-nan;LIN Guo-le;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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