直肠癌ELAPE手术会阴操作的神经保护

肛提肌外腹会阴联合切除术（ELAPE）已经成为治疗低位进展期直肠癌的重要术式。在降低局部复发率的同时，ELAPE手术由于切除更多肿瘤周围组织，有可能增加泌尿生殖神经损伤的发生率。笔者认为，在ELAPE手术的会阴操作过程中，对盆丛、阴部神经和神经血管束的保护是可行的，有助于保留术后的泌尿功能和性功能。在术前MRI分期的指导下，结合肿瘤的垂直浸润深度和环周生长情况，提出的个体化ELAPE技术，有助于在保证肿瘤根治性前提下，进一步减少手术创伤和保护会阴部神经。

The neuroprotection during perineal phase of extralevator abdominoperineal excision for low advanced rectal cancer

Extralevator abdominoperineal excision (ELAPE) has been an important surgical procedure for low advanced rectal cancer. In addition to reducing the local recurrence rate, ELAPE might increase the incidence of urogenital nerve injury due to the removal of more surrounding tissues compared with conventional operation. We supposed that the protection of pelvic plexus, pudendal nerve and neurovascular bundle is feasible during the perineal phase of ELAPE operation, which might help to retain the urinary and sexual function postoperatively. Under the guidance of preoperative MRI staging, combine the vertical infiltration depth and circumferential extension of the tumor, individualized ELAPE technology might reduce the surgical trauma and protect the perineal nerves with acceptable oncological outcomes.