Experience of cylindrical abdominoperineal resection for rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 许腾 , 张迎东 , 付海啸 , 符炜 , 宋军 ,  徐为

徐州医学院附属医院胃肠外科（江苏徐州 221002）;

Corresponding author：

徐为, Email: eryuanxuwei@126.com

Keywords：

低位直肠癌; 柱状经腹会阴切除术

DOI：

10.7507/1007-9424.20140150

Video：

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目的总结低位直肠癌采用柱状经腹会阴切除术（APR）的应用体会。方法徐州医学院附属医院普通外科于2010年1月至2013年7月期间采用柱状APR治疗22例低位直肠癌患者（柱状APR组），并与同期行传统APR治疗的35例患者（传统APR组）进行对比，分析术中、术后和随访的各项指标。结果与传统APR组比较，柱状APR组的环周切缘阳性率及术中穿孔率明显降低〔4.55%（1/22）比34.29%（12/35）和4.55%（1/22）比31.43%（11/35）〕，差异有统计学意义（P＜0.05）；2组手术时间、术中出血量、并发症发生率比较，差异无统计学意义（P＞0.05）。术后随访3～30个月（平均21个月），柱状APR组无肿瘤复发及远处转移患者，未见死亡病例；传统APR组出现盆底局部复发4例，远处转移3例，死亡2例。2组局部复发、远处转移及死亡率比较差异均无统计学意义（P＞0.05）。结论柱状APR可以切除更多的肿瘤周围组织，降低环周切缘阳性率，减少术中肠穿孔的发生，降低局部复发。

Citation： 许腾, 张迎东, 付海啸, 符炜, 宋军, 徐为. Experience of cylindrical abdominoperineal resection for rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(5): 627-629. doi: 10.7507/1007-9424.20140150 Copy

1.	Marr R, Birbeck K, Garvican J, et al.The modern abdominoperineal excision:the next challenge after total mesorectal excision[J].Ann Surg, 2005, 242(1):74-82.
2.	Nagtegaal ID, van de Velde CJ, Marijnen CA, et al.Low rectal cancer:a call for a change of approach in abdominoperineal resection[J].J Clin Oncol, 2005, 23(36):9257-9264.
3.	West NP, Finan PJ, Anderin C, et al.Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer[J].J Clin Oncol, 2008, 26(21):3517-3522.
4.	Heald RJ, Smedh RK, Kald A, et al.Abdominoperineal excision of the rectum-an endangered operation.Norman Nigro Lectureship[J].Dis Colon Rectum, 1997, 40(7):747-751.
5.	Holm T, Ljung A, Häggmark T, et al.Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer[J].Br J Surg, 2007, 94(2):232-238.
6.	郁宝铭.低位直肠癌的诊治进展[J].中国实用外科杂志, 2002, 22(1):34-37.
7.	Miles WE.A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908)[J].CA Cancer J Clin, 1972, 21(6):361-364.
8.	池畔, 陈致奋, 林惠铭, 等.腹腔镜经腹柱状腹会阴联合切除术治疗低位直肠癌[J].中华胃肠外科杂志, 2012, 15(6):589-593.
9.	Wibe A, Rendedal PR, Svensson E, et al.Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer[J].Br J Surg, 2002, 89(3):327-334.
10.	Hermanek P, Junginger T.The circumferential resection margin in rectal carcinoma surgery[J].Tech Coloproctol, 2005, 9(3):193-200.
11.	王振军, 韩加刚.直肠癌柱状腹会阴联合切除术的技术和应用[J].中华外科杂志, 2009, 47(3):229-231.
12.	West NP, Anderin C, Smith KJ, et al.Multicentre experience with extralevator abdominoperineal excision for low rectal cancer[J].Br J Surg, 2010, 97(4):588-599.
13.	王振军.不能保肛的直肠癌手术治疗进展及评价[J].中国实用外科杂志, 2012, 32(9):739-743.
14.	Tilney HS, Rasheed S, Northover JM, et al.The influence of circumferential resection margins on long-term outcomes following rectal cancer surgery[J].Dis Colon Rectum, 2009, 52(10):1723-1729.
15.	王振军.经腹经骶柱状切除技术治疗复发直肠癌[J].中国实用外科杂志, 2011, 31(4):358-360.
16.	de Campos-Lobato LF, Stocchi L, Dietz DW, et al.Prone or lithotomy positioning during an abdominoperineal resection for rectal cancer results in comparable oncologic outcomes[J].Dis Colon Rectum, 2011, 54(8):939-946.doi:10.1097/DCR.0b013e318221eb64.
17.	Bell SW, Dehni N, Chaouat M, et al.Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resection[J].Br J Surg, 2005, 92(4):482-486.

1. Marr R, Birbeck K, Garvican J, et al.The modern abdominoperineal excision:the next challenge after total mesorectal excision[J].Ann Surg, 2005, 242(1):74-82.
2. Nagtegaal ID, van de Velde CJ, Marijnen CA, et al.Low rectal cancer:a call for a change of approach in abdominoperineal resection[J].J Clin Oncol, 2005, 23(36):9257-9264.
3. West NP, Finan PJ, Anderin C, et al.Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer[J].J Clin Oncol, 2008, 26(21):3517-3522.
4. Heald RJ, Smedh RK, Kald A, et al.Abdominoperineal excision of the rectum-an endangered operation.Norman Nigro Lectureship[J].Dis Colon Rectum, 1997, 40(7):747-751.
5. Holm T, Ljung A, Häggmark T, et al.Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer[J].Br J Surg, 2007, 94(2):232-238.
6. 郁宝铭.低位直肠癌的诊治进展[J].中国实用外科杂志, 2002, 22(1):34-37.
7. Miles WE.A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908)[J].CA Cancer J Clin, 1972, 21(6):361-364.
8. 池畔, 陈致奋, 林惠铭, 等.腹腔镜经腹柱状腹会阴联合切除术治疗低位直肠癌[J].中华胃肠外科杂志, 2012, 15(6):589-593.
9. Wibe A, Rendedal PR, Svensson E, et al.Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer[J].Br J Surg, 2002, 89(3):327-334.
10. Hermanek P, Junginger T.The circumferential resection margin in rectal carcinoma surgery[J].Tech Coloproctol, 2005, 9(3):193-200.
11. 王振军, 韩加刚.直肠癌柱状腹会阴联合切除术的技术和应用[J].中华外科杂志, 2009, 47(3):229-231.
12. West NP, Anderin C, Smith KJ, et al.Multicentre experience with extralevator abdominoperineal excision for low rectal cancer[J].Br J Surg, 2010, 97(4):588-599.
13. 王振军.不能保肛的直肠癌手术治疗进展及评价[J].中国实用外科杂志, 2012, 32(9):739-743.
14. Tilney HS, Rasheed S, Northover JM, et al.The influence of circumferential resection margins on long-term outcomes following rectal cancer surgery[J].Dis Colon Rectum, 2009, 52(10):1723-1729.
15. 王振军.经腹经骶柱状切除技术治疗复发直肠癌[J].中国实用外科杂志, 2011, 31(4):358-360.
16. de Campos-Lobato LF, Stocchi L, Dietz DW, et al.Prone or lithotomy positioning during an abdominoperineal resection for rectal cancer results in comparable oncologic outcomes[J].Dis Colon Rectum, 2011, 54(8):939-946.doi:10.1097/DCR.0b013e318221eb64.
17. Bell SW, Dehni N, Chaouat M, et al.Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resection[J].Br J Surg, 2005, 92(4):482-486.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of cylindrical abdominoperineal resection for rectal cancer

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