低位直肠癌保留部分肛提肌重建盆底的改良经肛提肌外腹会阴联合切除手术

目的 探讨低位直肠癌保留部分肛提肌重建盆底的改良经肛提肌外腹会阴联合切除(ELAPE)手术操作的技术要点和临床效果.方法 2018年1月至2019年12月于南京大学医学院附属鼓楼医院胃肠外科收治的不能保肛的低位直肠癌患者,按腹腔镜直肠癌根治术常规清扫和分离,至肿瘤平面时根据肿瘤位于直肠的部位,分离健侧直肠系膜与肛提肌;...

Modified ELAPE operation with partial preservation of levator ani muscle for pelvic floor reconstruction in low rectal cancer

Objective To explore the technical points and clinical effects of modified ELAPE operation with partial preservation of levator ani muscle for pelvic floor reconstruction in low rectal cancer.Methods Patients with low rectal cancer who could not preserve anus and underwent modified ELAPE operation in the department of gastrointestinal surgery of Nanjing Drum Tower Hospital,from January 2018 to December 2019,were enrolled in this study.Routine dissection of laparoscopic radical resection of rectal cancer was performed,followed by separating the mesorectum and the levator ani muscle,according to the location of the tumor in the rectum.Then perineal operation was performed at the knife position,removing the affected levator ani muscle and preserving part of the healthy side levator ani muscle for pelvic floor reconstruction.Results A total of 26 patients underwent modified ELAPE operation,including 19 males and 7 females,aged from 29 to 76 years old.The average distance between the tumor and the anus was(2.54±1.05)cm.The average operation time was(285.0±35.8)min,and intraoperative hemorrhage was(92.3±39.2)ml.Postoperative pathology included 8 cases ofⅠ-Ⅱstage(30.8%)and 18 cases of III stage(69.2%).The average number of lymph node dissection was 13.6±3.6,and the circumferential resection margin was negative.The postoperative hospital stay was(11.6±2.9)days,and urinary retention occurred in 2 case.During the median follow-up period of 26(12~33)months,1 case had liver metastasis,the others had no signs of local or distant recurrence and metastasis,and no pelvic floor hernia occurred.Conclusions Modified ELAPE operation with partial preservation of levator ani muscle for pelvic floor reconstruction in low rectal cancer is safe and reliable and has high clinical application value.