低位直肠癌经前会阴切除的技术与评价

低位直肠癌由于位于人体盆腔底部邻近肛门,深在又隐蔽,在肿瘤生长过程中又往往极易侵犯女性的子宫、阴道,男性的前列腺及盆壁等组织.造成外科治疗难度大、疗效差和保肛率低.永久性的人工肛门更使患者感到沮丧和痛苦.近年来国际上开展了一种所谓"经前会阴超低位直肠前切除术"的新术式,专用于低位直肠癌的外科治疗.该术式在设计上打破了同类手术上百年来一直遵循的从腹盆腔开始分离直肠和肿瘤,最终经肛门切除肿瘤,然后采用手工吻合肠道的传统保肛模式,采用经前会阴切口的肿瘤切除和吻合器技术的肠道吻合方式.同传统的低位直肠癌手术相比,该术式具有更高的保肛率和更为满意的肛门功能,并能做到真正意义上的直肠全系膜切除(TME).

Evaluation of the anterior perineal planE for ultra-low anterior resection of the rectum

Low-lying rectal cancers are deeply located at the bottom of the pelvic cavity and are close to the anus. They are also very inclined to invade the adjacent organs (such as the uterus or vagina in women and the prostate gland in men) and the pelvic wall during the process of tumor growth. Based on these conditions, surgical treatment of low rectal cancer remains a major challenge associated with the poor therapeutic effect and low rate of sphincter-saving procedure. In addition, formation of a permanent stoma often brings about feelings of depression and agony to the patients. Recently, a new procedure called the -anterior perineal plane for ultra\|low anterior resection of the rectum (the APPEAR procedure) has been carried out worldwide , specifically for the surgical treatment of low\|lying rectal cancers. Design of this procedure differred greatly from the traditional pattern of the sphincter\|saving procedures for low rectal cancers, in which rectal dissection started from the abdominal and pelvic cavity and was followed by transanal tumor excision. Reconstruction of the bowel continuity was accomplished by hand\|sewn anastomosis. Such a pattern has been followed for over a hundred year. The APPEAR procedure makes tumor excision possible through the anterior perineal plane and the stapled bowel anastomosis. In comparison with the conventional surgical procedures for low\|lying rectal cancers, the APPEAR procedure ensures a higher rate of sphincter\|saving and a better postoperative anal function for the patients. Adherence to the principles of TME could be ensured by this technique.