腹会阴联合切除术（APE）和全直肠系膜切除（TME）明显改善了直肠癌病人的预后。然而，与直肠癌前切除手术（AR）相比，低位直肠癌的环周切缘（CRM）阳性率和术中穿孔（IOP）的发生率仍然很高，这是导致复局部发率高的重要因素。提肛肌外腹会阴联合切除术（ELAPE）可明显降低CRM阳性率和IOP发生率，增加局部根治性。在欧洲，ELAPE被认为是治疗低位直肠癌的外科新理念。ELAPE手术要求在会阴区沿提肛肌外侧平面操作，腹部手术遵循TME原则。明确解剖标志和操作原则可缩短外科医生的学习曲线。

New surgical conception of management for low rectal cancer: extralevator abdominoperineal excision        YE Ying-jiang, WANG Shan. Department of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044，China
Corresponding author: WANG Shan, E-mail: shwang60@sina.com
Abstract    The widespread adoption of the abdominoperineal excision (APE) and total mesotectal excision for rectal cancer has led to significant improvements in oncologic outcomes. However, the rate of circumferential resection margin (CRM) involvement and the incidence of intraoperative perforation (IOP) of APE for lower rectal cancer are still higher than those of anterior resection (AR) for higher rectal cancer. Extralevator abdominoperineal excision (ELAPE) for low rectal cancer has been introduced to decrease CRM and IOP and improve local radicality. ELAPE is recognized as a new concept for management of lower rectal cancer in Europe. ELAPE should be performed on the extralevator plane based on the principles of TME. Understanding anatomic landmark and operation principles can shorten the learning curve of surgery.