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

Authors：

 許騰 , 張迎東 , 付海嘯 , 符煒 , 宋軍 ,  徐為

徐州醫學院附屬醫院胃腸外科（江蘇徐州 221002）;

Corresponding?author：

徐為, Email: eryuanxuwei@126.com

Keywords：

低位直腸癌; 柱狀經腹會陰切除術

DOI：

10.7507/1007-9424.20140150

Video：

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目的總結低位直腸癌采用柱狀經腹會陰切除術（APR）的應用體會。方法徐州醫學院附屬醫院普通外科于2010年1月至2013年7月期間采用柱狀APR治療22例低位直腸癌患者（柱狀APR組），并與同期行傳統APR治療的35例患者（傳統APR組）進行對比，分析術中、術后和隨訪的各項指標。結果與傳統APR組比較，柱狀APR組的環周切緣陽性率及術中穿孔率明顯降低〔4.55%（1/22）比34.29%（12/35）和4.55%（1/22）比31.43%（11/35）〕，差異有統計學意義（P＜0.05）；2組手術時間、術中出血量、并發癥發生率比較，差異無統計學意義（P＞0.05）。術后隨訪3～30個月（平均21個月），柱狀APR組無腫瘤復發及遠處轉移患者，未見死亡病例；傳統APR組出現盆底局部復發4例，遠處轉移3例，死亡2例。2組局部復發、遠處轉移及死亡率比較差異均無統計學意義（P＞0.05）。結論柱狀APR可以切除更多的腫瘤周圍組織，降低環周切緣陽性率，減少術中腸穿孔的發生，降低局部復發。

Citation： 許騰, 張迎東, 付海嘯, 符煒, 宋軍, 徐為. 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, H?ggmark 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.	郁寶銘.低位直腸癌的診治進展[J].中國實用外科雜志, 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, 陳致奮, 林惠銘, 等.腹腔鏡經腹柱狀腹會陰聯合切除術治療低位直腸癌[J].中華胃腸外科雜志, 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.	王振軍, 韓加剛.直腸癌柱狀腹會陰聯合切除術的技術和應用[J].中華外科雜志, 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.	王振軍.不能保肛的直腸癌手術治療進展及評價[J].中國實用外科雜志, 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.	王振軍.經腹經骶柱狀切除技術治療復發直腸癌[J].中國實用外科雜志, 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, H?ggmark 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. 郁寶銘.低位直腸癌的診治進展[J].中國實用外科雜志, 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, 陳致奮, 林惠銘, 等.腹腔鏡經腹柱狀腹會陰聯合切除術治療低位直腸癌[J].中華胃腸外科雜志, 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. 王振軍, 韓加剛.直腸癌柱狀腹會陰聯合切除術的技術和應用[J].中華外科雜志, 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. 王振軍.不能保肛的直腸癌手術治療進展及評價[J].中國實用外科雜志, 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. 王振軍.經腹經骶柱狀切除技術治療復發直腸癌[J].中國實用外科雜志, 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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