| 摘要: |
| ［摘要］目的 探讨腹腔镜下经肛提肌外腹会阴联合切除术（Laparoscopic extralevator abdominoperineal excision，LELAPE） 治疗低位直肠癌的临床效果． 方法 回顾性分析昆明医科大学第一附属医院肿瘤科2013年1月至2016年1月42例低位直肠癌患者行LELAPE 的临床资料． 结果 42例全部顺利完成手术，平均手术时间（min）323.78（185～473），平均术中失血量168.81 mL（20～800 mL）；术中均未发生肠道穿孔及肿瘤破溃，未发生前列腺、精囊腺、阴道、尿道及神经等副损伤，环周切缘（CRM） 阴性41例（97.6%），阳性1例（2.4％），39例（92.9%）行盆底重建，3例（7.1%）未行盆底重建；术后并发症：未行盆底重建 1例小肠坠入盆底致肠梗阻；排尿功能障碍1例，会阴部切口脂肪液化致延迟愈合4例（9.5%），其中合并盆底积液及感染2例（均系术前放化同期治疗患者），其余患者均甲级愈合；术后拔引流管时间10.9 d（6～20），术后拔尿管时间7 d（5～14 d），术后住院时间15.2 d（6～31）；术后病理分期：Ⅰ期0例， II期20例（47.6%），III期21例（50%），IV期1例（2.4%）；术后随访3～36月，会阴区局部复发3例，局部复发率为7.1%．结论 LELAPE手术治疗低位直肠癌，可以降低CRM阳性率，降低术中肠穿孔等副损伤的发生率，减少术后并发症的发生率，降低术后局部复发率，从而可能改善患者的预后，提高患者的生存率，因此LELAPE手术治疗低位直肠癌应该是安全、可行的术式，值得临床进一步推广应用． |
| 关键词: ［关键词］低位直肠癌 腹腔镜肛提肌外腹会阴联合切除术 术中及术后并发症 |
| DOI： |
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| 基金项目:［基金项目］云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目（2015FB035） |
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| The Clinical Application of Laparoscopic Extralevator Abdominoperineal Excision in Treatment of Low Rectal Cancer |
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WEN Zheng-qi1,2
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1.（1）Dept. of Oncology;2.２）Prevention and Health Section，The 1st Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032，China）
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| Abstract: |
| ［Abstract］Objective To investigation the clinical effect of treatment for low rectal cancer by Laparoscopic extralevator abdominoperineal excision（LELAPE）. Method We retrospectively analyzed the clinical data of 42 patients with low rectal cancer who underwent LELAPE from January 2013 to January 2016．Results This 42 cases all successfully completed the operation，The mean operative time（min）was 323.78 min（185～473），and the mean intraoperative blood loss（mL）was 168.81 mL（20～800）. No intestinal perforation and tumor perforation occurred during the operation，and no secondary injury occurred in the prostate, seminal vesicle gland，vagina，urethra and nerve. Circumferential resection margin （CRM）was negative in 41 cases（97.6%），positive in 1 case （2.4％），pelvic floor reconstruction in 39 cases（92.9%），and no pelvic floor reconstruction in 3 cases（7.1%）. Postoperative complications: intestinal obstruction due to small bowel falling into the pelvic floor occurred in 1 case of no pelvic floor reconstruction; dysfunction of urination occurred in 1 case, delayed healing due to fat liquefaction of perineal incisionoccurred in 4 cases（9.5%），includingn 2 cases complicated with pelvic effusion and infection （who received preoperative chemoradiotherapy during the same period）, the rest of the patients were healed; the time of postoperative removal of drainage tube was 10.9 days（6～20），the postoperative extubation time was 7 days （5-14）, the postoperative hospitalization time was 15.2 days（6-31）. Postoperative pathological staging：there was no cases of stage I, 20 cases of stage II（47.6%）， 21 cases of stage III（50%）， 1 case of stage IV（2.4%）. The postoperative follow up time was 3-36 months, there were 3 cases of local recurrence in perineal area, local the recurrence rate was 7.1%. Conclusion LELAPE in surgical treatment of low rectal cancer can reduce the positive rate of CRM, the incidence of intraoperative secondary injury such as rectal perforation, the incidence of postoperative complications, reduce the postoperative local recurrence rate, which may improve the patient's prognosis and improve the survival rate of patients, so LELAPE in surgical treatment of low rectal cancer should be safe and feasible , and is worth further clinical application. |
| Key words: ［Key words］Low rectal cancer LELAPE Intraoperative and postoperative complications |