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目的探讨经提肛肌外腹会阴联合切除术(extralevator abdom inoperineal excision,ELAPE)在低位直肠癌手术中的初步应用结果。方法回顾性分析2011年9月至2012年4月北京大学人民医院胃肠外科7例接受ELAPE的低位直肠癌病人的临床资料。结果 7例病人平均手术时间280min,平均出血量150mL,术中未发生医源性肠管穿孔,切除标本均无"外科腰",术后会阴切口延迟愈合1例,肠梗阻1例。结论 ELAPE治疗低位直肠癌安全可行,可降低术中穿孔发生率、可能降低环周切缘阳性率,短期随访预后良好,有望成为治疗进展期低位直肠癌的推荐术式。

Application of extralevator abdominoperineal excision in the surgical treatment of low rectal cancer

Objective To explore the preliminary application result of extralevator abdominoperineal excision(ELAPE) for low rectal cancer. Methods The clinical pathological factors of seven patients with low rectal cancer performed ELAPE from September 2011 to April 2012 in Department of Gastroenterological Surgery,Peking University People’s Hospital were analyzed retrospectively. Results The mean operation time was 280 minutes. The mean bleeding amount was 150 mL. No iatrogenic intestinal perforation was found in operation. All specimens were proved circumferential resection margin(CRM) without"surgical waist". One patient with delayed union of perineal incision was healed uneventfully. Postoperative intestinal obstruction was occurred in one patient. Conclusion ELAPE is a safe and feasible surgical approach of low rectal cancer. ELAPE might reduce the incidence of positive CRM and intestinal perforation and has a better prognosis than conventional abdominoperineal resection(APR) . It might become a recommended surgical approach for low rectal cancer in the future.