切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 36 -39. doi: 10.3877/cma.j.issn.1674-3946.2022.01.012

论著

肛提肌外腹会阴联合术与传统会阴联合术治疗低位直肠癌的远期随访研究
邓褫夺1, 林学祥1, 李俊锐1, 武少清2,()   
  1. 1. 543000 广西梧州,广西壮族自治区桂东人民医院 普外科
    2. 435000 湖北黄石,鄂东医疗集团市中心医院 普外科
  • 收稿日期:2021-03-22 出版日期:2022-02-26
  • 通信作者: 武少清

Long-term follow-up study of the treatment of low rectal cancer with the combined operation of external abdominal perineum of levator ANI and traditional perineal combined operation

Chiduo Deng1, Xuexiang Lin1, Junrui Li1, Shaoqing Wu2,()   

  1. 1. Department of General Surgery, Guidong People’s Hospital, Wuzhou Guangxi Zhuang Autonomous Region 543000, China
    2. Department of general surgery, Central Hospital of Edong medical group, Huangshi Hubei Province 435000, China
  • Received:2021-03-22 Published:2022-02-26
  • Corresponding author: Shaoqing Wu
  • Supported by:
    Hubei Health Committee Project(WJ2019H184)
引用本文:

邓褫夺, 林学祥, 李俊锐, 武少清. 肛提肌外腹会阴联合术与传统会阴联合术治疗低位直肠癌的远期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(01): 36-39.

Chiduo Deng, Xuexiang Lin, Junrui Li, Shaoqing Wu. Long-term follow-up study of the treatment of low rectal cancer with the combined operation of external abdominal perineum of levator ANI and traditional perineal combined operation[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(01): 36-39.

目的

探讨肛提肌外腹会阴联合术(ELAPE)与传统会阴联合术(APR)治疗低位直肠癌的远期疗效。

方法

回顾性分析2012年9月至2015年12月109例低位直肠癌手术患者资料,根据术式不同分为ELAPE组(n=58例)和APR组(n=51例)。采用SPSS 23.0统计软件分析数据,手术相关指标等计量资料以(

xˉ
±s)表示,采用独立样本t检验;并发症、术中穿孔率等计数资料采用χ2检验;生存分析采用K-M法,Log Rank检验。P<0.05为差异有统计学意义。

结果

ELAPE组手术时间比APR组长,术中出血量比APR组低(P<0.05);两组患者术后排气时间、住院时间、淋巴结清扫数量、术后5年生存率、并发症总发生率相比,差异无统计学意义(P>0.05);ELAPE组术中穿孔率、环周切缘(CRM)阳性率、局部复发和远处转移发生率均比APR组低(P<0.05)。

结论

ELAPE术与APR术治疗低位直肠癌均可行,两者远期生存率相似,但ELAPE术术中出血量较少,且局部复发和远处转移发生率较低。

Objective

To investigate the long-term efficacy of ELAPE and APR in the treatment of low rectal cancer.

Methods

A retrospective analysis of 109 patients undergoing low rectal cancer from September 2012 to December 2015 was analyzed and divided into ELAPE group(n=58 cases)and APR group(n=51 cases)according to different surgical procedures. SPSS 23.0 statistical analysis software was used to analyze the data. Surgical indicators were expressed as(

xˉ
±s),independent sample t test was used,Statistical data such as complication and intraoperative perforation rate were compared by χ2 test. Survival analysis was performed by K-M method and Log Rank test. P<0.05 was considered statistically significant.

Results

The operation time of the ELAPE group was longer than that of the APR group,and the intraoperative blood loss was lower than that of the APR group(P<0.05);There were no significant differences in the postoperative exhaust time,hospitalization time,number of lymph node dissections,5-year postoperative survival rate,and total incidence of complications between two groups(P>0.05). The intraoperative perforation rate,the positive rate of circumferential margin(CRM),incidence of local recurrence and distant metastasis in ELAPE group were lower than those in the APR group(P<0.05).

Conclusion

Both ELAPE and APR are feasible for the treatment of low rectal cancer,and their long-term survival rates are similar. However,there is less bleeding in ELAPE,and the incidence of local recurrence and distant metastasis is lower.

表1 109例低位直肠癌不同术式两组患者基线资料比较[(
xˉ
±s),例]
表2 109例低位直肠癌不同术式两组患者手术相关指标比较(
xˉ
±s
表3 109例低位直肠癌不同术式两组患者术中穿孔率、CRM阳性率及并发症比较[例(%)]
表4 109例低位直肠癌不同术式两组患者远期生存状况比较[例(%)]
[1]
谢爽,张春旭,尹智渊,等. 改良腹腔镜肛提肌外腹会阴联合切除术治疗超低位直肠癌的近期疗效[J]. 中华消化外科杂志202019(10):1091-1097.
[2]
周乐其,严夏霖,冯波,等. 腹腔镜关闭盆底腹膜的腹会阴联合切除术治疗低位直肠癌的安全性及近期疗效[J]. 中华消化外科杂志201918(8):768-772.
[3]
Hawkins AT,,Albutt K,,Wise PE,et al. Abdominoperineal Resection for Rectal Cancer in the Twenty-First Century:Indications,Techniques,and Outcomes[J]. J Gastrointest Surg201822(8):1477-1487.
[4]
邓海军,沈智勇,朱煜 . 腹腔镜直肠癌低位前切除术[J]. 中华普外科手术学杂志(电子版)201913(1):17.
[5]
田川,张东兴,章立,等. 腹腔镜辅助经肛提肌外腹会阴联合切除术治疗低位直肠癌[J]. 广东医学201839(3):386-389,393.
[6]
磨鹏诗,杨平,陈应驹. 腹腔镜辅助TaTME术在低位直肠癌患者中的临床效果及安全性研究[J]. 中华普外科手术学杂志(电子版)201913(2):155-158.
[7]
Qi XY,,Cui M,,Liu MX,et al.Extralevator abdominoperineal excision versus abdominoperineal excision for low rectal cancer:a meta-analysis[J].Chin Med J(Engl)2019132(20):2446-2456.
[8]
陈海鹏,赵志勋,关旭,等. 经自然腔道取标本手术联合Parks术在低位直肠癌保肛手术中的临床研究[J]. 腹腔镜外科杂志201823(11):836-840.
[9]
彭吒,李坚,丁海波. 腹腔镜联合完全内括约肌切除术治疗极低位直肠癌[J]. 中南大学学报(医学版)201843(11):61-67.
[10]
Shen Z,,Bu Z,,Li A,et al.Multicenter study of surgical and oncologic outcomes of extra-levator versus conventional abdominoperineal excision for lower rectal cancer[J].Eur J Surg Oncol202046(1):115-122.
[11]
韩加刚,王振军,魏广辉,等. 生物补片在低位进展期直肠癌肛提肌外腹会阴联合切除术盆底重建中的应用价值[J]. 中华消化外科杂志201817(2):161-167.
[12]
戈伟,陈刚,蒋松松,等. 组织再生修复材料重建盆底在低位直肠癌经肛提肌外腹会阴联合切除术的临床应用[J]. 中华胃肠外科杂志201821(1):79-82.
[13]
谢爽,张春旭,尹智渊,等. 改良腹腔镜肛提肌外腹会阴联合切除术治疗超低位直肠癌的近期疗效[J]. 中华消化外科杂志202019(10):1091-1097.
[14]
李兴,李洪亮. 腹腔镜经腹会阴联合切除术与传统手术治疗低位直肠癌的近期随访比较[J/D]. 中华普外科手术学杂志(电子版)202014(2):158-161.
[15]
李俊川,杨烈,康乐平,等. 腹腔镜经肛提肌外腹会阴联合切除术治疗低位进展期直肠癌疗效观察[J]. 海南医学201930(5):56-59.
[1] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[2] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[3] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[4] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[5] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[6] 庄宝雄, 邓海军. 单孔+1腹腔镜直肠癌侧方淋巴结清扫术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 601-601.
[7] 郑民华, 蒋天宇, 赵轩, 马君俊. 中国腹腔镜直肠癌根治术30年发展历程与未来[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 591-595.
[8] 池畔, 黄胜辉. 中国腹腔镜直肠癌根治术30年来的巨大进步[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 596-600.
[9] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[10] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[11] 陈杰, 武明胜, 李一金, 李虎, 向源楚, 荣新奇, 彭健. 低位直肠癌冷冻治疗临床初步分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 494-498.
[12] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[13] 王灿, 樊昊, 张卫, 于冠宇. LARS 评分的研制回顾与应用现状[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 519-523.
[14] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[15] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
阅读次数
全文


摘要