个体化经肛提肌外腹会阴联合切除术治疗低位进展期直肠癌的探索.docVIP

个体化经肛提肌外腹会阴联合切除术治疗低位进展期直肠癌的探索 韩加刚 王振军 魏广辉 高志刚 杨勇 翟志伟 赵宝成 首都医科大学附属北京朝阳医院普通外科 X 关注成功！ 加关注后您将方便地在 我的关注中得到本文献的被引频次变化的通知！ 新浪微博 腾讯微博 人人网 开心网 豆瓣网 网易微博 摘????要： 目的 探讨个体化经肛提肌外腹会阴联合切除术 (extralevator abdominoperineal excision, ELAPE) 治疗低位进展期直肠癌的疗效。方法 2011年6月至2015年6月, 在术前磁共振成像 (magnetic resonance imaging, MRI) 精准指导下, 56例低位进展期直肠癌患者接受个体化ELAPE。观察肿瘤环周切缘、术中穿孔、术后合并症和局部复发情况。结果 术前50例 (89.3%) 患者接受新辅助治疗。无围术期死亡病例, 术后常见合并症包括:会阴伤口感染 (9/56, 16.1%) 、性功能障碍 (5/41, 12.2%) 、尿潴留 (4/56, 7.1%) 和慢性会阴部疼痛 (3/56, 5.4%) 。术后环周切缘 (circumferential resection margin, CRM) 阳性3例 (5.4%) , 术中肠管穿孔2例 (3.6%) 。平均随访35个月 (1260个月) , 局部复发2例 (3.6%) 。结论 在新辅助治疗和术前MRI的精准指导下, 在不影响手术根治性的前提下, 个体化ELAPE是治疗低位进展期直肠癌的安全可行技术。 关键词： 直肠癌; 个体化; 经肛提肌外腹会阴联合切除术; 合并症; 局部复发; 作者简介：Wang Zhenjun, E-mail:wang3zj@ 收稿日期：2017-10-16 基金：国家高技术研究发展计划 (863计划) (2015AA033602) Results of individual extralevator abdominoperineal resection for locally advanced low rectal cancer Han Jiagang Wang Zhenjun Wei Guanghui Gao Zhigang Yang Yong Zhai Zhiwei Zhao Baocheng Department of General Surgery, Beijing Chaoyang Hosptial, Capital Medical University; Abstract： Objective To evaluate the safety and efficacy of individualized extralevator abdominoperineal excision (ELAPE) for locally advanced low rectal cancer.Methods Fifty-six patients who underwent individualized abdominoperineal resection (APR) based on magnetic resonance imaging (MRI) from June 2011 to June 2015 were evaluated.The main outcome measures were circumferential resection margin involvement, intraoperative perforation, postoperative complications, and local recurrence.Results During the study, fifty patients (89.3%) received preoperative chemoradiotherapy.The common complications included perineal wound infection (9/56, 16.1%) , sexual dysfunction (5/41, 12.2%) , urinary retention (4/56, 7.1%) and chronic perineal pain (3/56, 5.4%) .A positive circumferential resection margin (CRM) was demonstrated in 3 (5.4%) patients, and intraoperative perforations occurred in 2 (3.6%) patient.The l