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

发布时间：2018-05-25 13:59

本文选题：直肠癌 + 个体化　；参考：《首都医科大学学报》2017年06期

【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(12~60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。
[Abstract]:Objective to evaluate the efficacy of individualized excision of extralevator abdominoperineal excision (ELAPE) in the treatment of low advanced rectal cancer. Methods from June 2011 to June 2015, 56 patients with low advanced rectal cancer received individualized ELAPE under the guidance of preoperative magnetic resonance imaging (MRI). Tumor circumferential margin, intraoperative perforation, postoperative complications and local recurrence were observed. Results Neoadjuvant therapy was performed in 50 patients (89. 3%) before operation. There were no perioperative deaths, and common complications included: perineal wound infection, 9 / 56 / 16.1, sexual dysfunction, 5 / 41 / 12. 2, urine retention, 4 / 5 / 56 / 7. 1) and chronic perineum pain, 3 / 5 / 56 / 5. 4%. The circumferential resection margin was positive in 3 cases (5.4%) and intestinal perforation in 2 cases (3.6%). The average follow-up time was 35 months, 12 ~ 60 months, 2 cases of local recurrence were 3. 6%. Conclusion under the guidance of neoadjuvant therapy and preoperative MRI, individualized ELAPE is a safe and feasible technique for the treatment of low advanced rectal cancer.
【作者单位】：首都医科大学附属北京朝阳医院普通外科;
【基金】：国家高技术研究发展计划(863计划)(2015AA033602) 国家自然科学基金(81541101) 首都临床特色应用研究(Z121107001012131) 新世纪百千万人才工程(09-911-002) 首都卫生发展科研专项(2009-3109,2014-4-2033) 北京朝阳医院1351人才培养计划项目首都医科大学基础-临床研究重点课题(15JL03)~~
【分类号】：R735.37

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