中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (04): 348-351.

• 临床新技术 • 上一篇    下一篇

柱状经腹会阴直肠癌切除术及其改进（附10例报告）

王振军，高志刚，韩加刚，杨增辉，杜燕夫，李敏哲，杨新庆   

  1. 首都医科大学附属北京朝阳医院普外科，北京，100020
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-04-03 发布日期:2009-04-03

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-04-03 Published:2009-04-03

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摘要：

目的 报告柱状经腹会阴直肠癌切除术（cylindrical abdominoperineal resection）和使用人类脱细胞真皮基质（human acellular dermal matrix，HADM）进行盆底重建的初步应用结果。方法 北京朝阳医院普外科自2008年1月至2009年1月，采用柱状经腹会阴直肠癌切除术治疗10例低位直肠癌。腹部操作中不将直肠系膜从肛提肌分离。会阴操作中采用俯卧折刀位，在进入盆腔之前环周解剖出肛提肌。切除尾骨和部分骶5，切开Waldeyer筋膜进入盆腔，从后向前切断两侧肛提肌。在会阴横肌的后方切断盆底肌纤维并将直肠和肛管完整切除，标本呈圆柱状。盆底缺损使用人脱细胞真皮基质重建。结果 所有病人无直肠穿孔，病理示环周切缘阴性，术后会阴伤口I期愈合。平均随访9个月，无会阴伤口感染、裂开、膨出和疝的发生。发生无症状血清肿1例和会阴疼痛2例。结论 柱状经腹会阴直肠癌切除术可以降低Miles手术环周切缘阳性率和肠穿孔率，HADM盆底重建可以降低手术难度。

关键词: 直肠癌, 柱状经腹会阴直肠癌切除术, 人脱细胞真皮基质, 盆底重建

Abstract:

Preliminary result of modified cylindrical abdominoperineal resection：A report of 10 cases WANG Zhen-jun, GAO Zhi-gang, HAN Jia-gang, et al. Department of General Surgery, Capital Medical University Affiliated Beijing Chao-Yang Hospital, Beijing 100020, China Corresponding author: WANG Zhen-jun，E-mail:wang3zj@sohu.com Abstract Objective To report the preliminary result of cylindrical abdominoperineal resection (cylindrical APR) and pelvic reconstruction with human acellular dermal matrix (HADM). Methods Cylindrical APR was performed in 10 consecutive patients with advanced very low rectal cancer between January 2008 and January 2009. The mesorectum was not dissected off the levator muscles at abdominal part of the operation, the perineal part of the operation was done in the prone position. The levator muscles were exposed circumferentially. The coccyx and part of the 5th sacrum were disected and Waldeyer’s fascia divided. The levator muscles were divided laterally on both sides from posterior to anterior. The remaining pelvic floor muscle fibres were divided just posterior to the transverse perineal muscles and the levator muscles were resected en bloc with the anus and lower rectum. The specimen was cylindrical. The pelvic defects were reconstructed with HADM. Results There was no bowel perforation，and all specimens were proved CMR negative by pathology. Perineal wounds were healed uneventfully. After 9 months’ follow-up, no patient developed perineal wound infection, breakdown, bulge or herniation. There were three complications including one patient developed seroma and two with perineal pain. Conclusion Clindrical APR and HADM pelvic reconstruction reduced circumferential margin positive and rectum perfortion rate, and made the procedure safer.

Key words: rectal carcinoma, cylindrical abdominoperineal resection, human acellular dermal matrix, pelvic reconstruction