目的

研究Marcille三角入路在局部晚期直肠癌盆腔脏器联合切除术中临床应用效果。

方法

回顾性选取2020年10月至2023年10月18例局部晚期直肠癌行盆腔脏器联合切除术患者的临床资料。分析患者围手术期指标、术后并发症；进行随访统计患者生存情况，采用SPSS22.0统计软件分析数据。手术时间、术中出血量等符合正态分布的计量资料用（）表示，应用Kaplan-Meier分析患者预后生存情况。

结果

18例患者均顺利完成盆腔脏器联合切除术，无围手术期死亡。平均手术时间（420.7±52.6）min，术中出血量（780.4±80.2）ml，术后首次排气时间（3.2±0.5）d，住院时间（11.6±2.5）d，临近器官受累情况：宫颈8例、子宫内膜4例、前列腺7例、膀胱5例、精囊腺6例，其中高分化癌8例，中分化癌10例。患者术中重建均采用基底膜生物补片行空盆腔处理，5例行生殖系统重建，1例行血管重建采取脱细胞牛心包补片，2例行输尿管重建，回肠代替膀胱1例，缝合修补1例；术后出现肠梗阻1例，腹腔感染1例，下肢静脉血栓1例，尿路感染1例、骨盆中部缺血1例，会阴部死腔感染3例，骶前出血2例，上述并发症均采取保守治疗后痊愈，并发症总发生率为55.6%；Kaplan-Meier生存分析，纳入患者3年累积中位生存时间33.5个月，累积无病中位生存时间19.8个月。

结论

局部晚期直肠癌盆腔脏器联合切除术中采用Marcille三角入路安全可行，建议临床推广使用。

Objective

To study the clinical application effect of the Marcille triangular approach in pelvic organ combined resection for locally advanced rectal cancer.

Methods

The clinical data of 18 patients with locally advanced rectal cancer who underwent pelvic organ combined resection from October 2020 to October 2023 were retrospectively selected. The perioperative indexes and postoperative complications of the patients were analyzed; the survival status of the patients was statistically analyzed through follow-up,and the data were analyzed using the statistical software SPSS22.0. Measurement data that conformed to the normal distribution, such as the operation time and intraoperative blood loss, were expressed as (), and the Kaplan-Meier method was applied to analyze the prognostic survival of the patients.

Results

All 18 patients successfully completed the pelvic organ combined resection, and there was no perioperative death. The average operation time was (420.7±52.6) min, the intraoperative blood loss was (780.4±80.2) ml, the first postoperative exhaust time was (3.2±0.5) d, and the hospital stay was (11.6±2.5) d. The involvement of adjacent organs was as follows: 8 cases of the cervix, 4 cases of the endometrium, 7 cases of the prostate, 5 cases of the bladder,and 6 cases of the seminal vesicles. Among them, there were 8 cases of well-differentiated carcinoma and 10 cases of moderately differentiated carcinoma. All patients underwent the treatment of the empty pelvic cavity with a basement membrane biological patch during the intraoperative reconstruction. Reproductive system reconstruction was performed in 5 cases, vascular reconstruction was performed in 1 case using an acellular bovine pericardium patch, ureteral reconstruction was performed in 2 cases, bladder substitution with the ileum was performed in 1 case, and suture repair was performed in 1 case. Postoperatively, there was 1 case of intestinal obstruction, 1 case of abdominal cavity infection, 1 case of lower extremity venous thrombosis, 1 case of urinary tract infection, 1 case of ischemia in the middle of the pelvis, 3 cases of perineal dead space infection,and 2 cases of presacral bleeding. All the above complications were cured after conservative treatment, and the total complication rate was 55.6%. According to the Kaplan-Meier survival analysis, the cumulative median survival time of the included patients at 3 years was 33.5 months, and the cumulative median disease-free survival time was 19.8 months.

Conclusion

The Marcille triangular approach is safe and feasible in pelvic organ combined resection for locally advanced rectal cancer, and it is recommended for clinical promotion and application.