低位直肠癌保留部分肛提肌重建盆底的改良ELAPE手术15例报道

目的 探讨低位直肠癌保留部分肛提肌重建盆底的改良ELAPE手术操作的技术要点和临床效果。方法 2018年1月至2018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；完成腹部操作后，改折刀位行会阴部操作，切除患侧肛提肌，并保留部分健侧肛提肌行重建盆底的改良ELAPE手术。结果 共15例患者行保留部分肛提肌重建盆底的改良ELAPE手术，其中男性10例，女性5例，年龄（29-76）岁，肿瘤距肛门距离平均（2.5±1.02）cm，平均手术时间（302±35.7）min，平均出血（100±46.3）ml；术后病理I-II期5（33.3%）例，III期10（66.7%）例。平均淋巴结清扫（14±3.0）枚，环周切缘均阴性。术后住院时间（12.3±3.2）天，出现尿潴留1例。中位随访时间16（13~21）月，1例出现肝脏转移，其余均无局部及远处复发转移征象；均无盆底疝发生。结论 低位直肠癌保留部分肛提肌重建盆底的改良ELAPE手术安全可靠，具有较高临床应用价值。

Modified ELAPE operation with partial preservation of levator ani muscle for pelvic floor reconstruction in low rectal cancer: a report of 15 cases

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 2018, 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 15 patients underwent modified ELAPE operation, including 10 males and 5 females, aged from 29 to 76 years old. The average distance between the tumor and the anus was (2.5 ±1.02) cm. The average operation time was (302 ±35.7) min, and intraoperative hemorrhage was (100 ±46.3) ml. Postoperative pathology included 5 cases of I-II stage (33.3%) and 10 cases of III stage (66.7%). The average number of lymph node dissection was 14 ±3.0, and the circumferential resection margin was negative. The postoperative hospital stay was (12.3 ±3.2) days, and urinary retention occurred in 1 case. During the median follow-up period of 16 (13-21) 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.