腹腔镜提肛肌外腹会阴联合切除术治疗低位直肠癌的临床应用

目的:探讨腹腔镜提肛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:回顾分析2011年6月至2013年1月为15例低位直肠癌患者行LELAPE的临床资料。结果:手术均顺利完成,手术时间平均(258.8±52.1)min,术中出血量平均(130±48.4)ml,术中未发生医源性肠管穿孔,切除标本为"柱状",无"外科腰"。术后下床活动时间平均(35.1±12.5)h,肠功能恢复时间平均(60.6±24.5)h,会阴部引流管拔除时间平均(6.2±1.5)d,会阴部切口拆线时间平均(15.6±2.52)d,术后平均住院(12.1±3.4)d;术后未发生排尿障碍及勃起障碍;1例发生会阴部切口延迟愈合,1例发生不全肠梗阻,经对症治疗后痊愈出院。无死亡病例。患者均获随访,随访1～19个月,无复发及死亡病例。结论:LELAPE可降低标本环周切缘阳性率及术中标本穿孔率,改善预后,未增加并发症发生率及会阴部创伤,为术者提供了良好的手术视野。LELAPE治疗低位直肠癌是安全、可行、理想的术式。

Clinical application of laparoscopic extralevator abdominoperineal excision in the treatment of low rectal carcinoma

Objective:To explore the application result of laparoscopic extralevator abdominoperineal excision(LELAPE) for low rectal cancer.Methods:The clinical data of 15 patients with low rectal cancer performed LELAPE from Jun.2011 to Jan.2013 were analyzed retrospectively.Results: All operations were successful.The mean operative time was(258.8±52.1) min.The mean blood loss was(130±48.4) ml.No iatrogenic intestinal perforation was found in operation.All specimens were column,and were proved circumferential resection margin without "surgical waist".The mean postoperative out-of-bed activity time was(35.1±12.5) h,the mean recovery time of gastrointestinal function was(60.6±24.5) h,the mean removal time of perineal drainage tube was(6.2±1.5) d,the mean taking out stitches time of perineal incision was(15.6±2.52) d,the mean postoperative hospital stay time was(12.1±3.4) d.There were no urination disorders and erectile dysfunction occurred postoperatively.There were a patient with a delay in healing of perineal incision,and a patient with postoperative incomplete intestinal obstruction.The patients were discharged after symptomatic treatment.The follow-up period of 15 patients was 1-19 months,there was no local recurrence or death.Conclusions:LELAPE is a safe,feasible and ideal surgical approach for low rectal cancer,which can decrease positive rate of circumferential resection margin and intraoperative perforation rate of specimen,improve prognosis,provide good field of vision,and does not increase complication incidence or perineal trauma.