低位直肠癌经肛提肌外腹会阴联合切除术的研究进展

目的 肛提肌外腹会阴联合切除术(exralevator abdominoperineal excision,ELAPE)的提出旨在改善低位直肠癌的手术安全性和肿瘤预后,但其应用仍存在争议.本研究总结ELAPE治疗低位直肠癌的最新研究进展.方法 应用PubMed及CNKI期刊全文数据库检索系统,以"肛提肌外、腹会阴联合切除术和低位直肠癌"为关键词,检索2006-01-2015-12的相关文献.纳入标准:(1)ELAPE的疗效分析;(2)ELAPE术后并发症的处理;(3)ELAPE的适用范围;(4)ELAPE体位的选择.排除标准:(1)综述和会议汇编等相关文献;(2)实验设计不严谨.根据纳入和排除标准,符合分析53篇,其中英文文献45篇,中文文献8篇.结果手术是低位直肠癌的首选治疗方案,ELAPE作为治疗低位直肠癌新的术式,目前其手术体位,术后盆底重建,手术疗效及适用范围等方面存在诸多争议,仍需要进一步探讨,尤其是手术疗效及患者术后生活质量亟需进一步的前瞻性研究来验证.结论ELAPE尚不能取代传统腹会阴联合切除术(abdominoperinealexcision,APE)而成为治疗低位直肠癌的标准术式,ELAPE术式可能还需要进一步优化和改进.

Research advance of extralevator abdominoperineal excision for low rectal cancer

OBJECTIVE Extralevator abdominoperineal resection (ELAPE) has been recommended for improving surgical safety and oncological outcomes of low rectal cancer,but its application is still controversial.The aim of this paper was to summarize the latest research advance of ELAPE for low rectal cancer.METHODS Based on PubMed and CNKI databases,the related papers published between 2006-01 and 2015-12 were searched using exralevator,abdominoperineal excision and low rectal cancer as terms.Inclusion criteria:efficacy analysis of ELAPE;treatment of postoperative complications of ELAPE;the range of application of ELAPE;the selection of ELAPE position.Exclusion criteria:papers with types of review and meeting compilation;experimental design is not rigorous.According to the inclusion criteria,a total of 53 papers were included and analyzed.Including 45 references in English and Chinese with 8 references.RESULTS Surgery is the first choice for the treatment of low rectal cancer,and ELAPE as a new operation for rectal cancer,its surgery position,reconstruction of postoperative pelvic floor,efficacy and scope of operation existed many disputes,which still need to be further explored,especially its operation effect and quality of life in postoperative patients were needed to validate in further prospective studies.CONCLUSION ELAPE could not replace the traditional APE as the standard operation for treatment of low rectal cancer,furthermore ELAPE may also need to be optimized and improved in the further.