肛提肌外腹会阴联合切除术对低位直肠癌病人近期预后的影响
Effect of the ELAPE on the short-term prognosis in patients with low rectal cancer
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摘要: 目的：探讨肛提肌外腹会阴联合切除术（extralevator abdominoperineal excision，ELAPE）对低位直肠癌病人近期预后影响，为改善低位直肠癌病人近期预后提供参考依据。方法：收集低位直肠癌病人67例，根据不同手术方式分为传统腹会阴联合切除术（abdomino-perineal resection，APE）组（n=31）和ELAPE组（n=36）。比较2组病人的手术情况、术后恢复情况、发症发生率及术后随访结果。结果：ELAPE组手术时间明显高于APE组，术中出血量、环周切缘阳性率均显著低于APE组（P<0.05~P<0.01）；2组病人淋巴结清扫数目和术中穿孔率差异无统计学意义（P>0.05）；ELAPE组会阴引流管拔除时间明显高于APE组（P<0.05）；2组病人排气时间、排便时间、进食流质时间、会阴引流量、住院时间、会阴伤口拆线时间差异均无统计学意义（P>0.05）；术后随访6~24个月，ELAPE组远处转移率和死亡率均明显低于APE组（P<0.01和P<0.05），2组局部复发率差异无统计学意义（P>0.05）。结论：与传统APE比较，ELAPE减少了低位直肠癌病人术中出血量，并降低了环周切缘阳性、远处转移及死亡发生率，明显改善了病人近期预后，值得临床重视。
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关键词:
- 直肠肿瘤 /
- 肛提肌外腹会阴联合切除术 /
- 腹会阴联合切除术
Abstract: Objective:To investigate the effects of extralevator abdominoperineal excision(ELAPE) on short-term prognosis in patients with low rectal cancer,and provide the basis in improving the short-term prognosis of patients.Methods:According to the different surgical methods,67 patients with low rectal cancer were divided into the abdomino-perineal resection(APE) group(n=31) and ELAPE group(n=36).The operation situation,postoperative recovery,incidence rate of complications and postoperative follow-up result were compared between two groups.Results:The operation time in ELAPE group was significantly longer than that in APE group,and the peroperative bleeding and positive rate of circumferential margin in ELAPE group was significantly lower than those in APE group(P<0.05 to P<0.01).The differences of the number of lymph node dissection and perforation rate between two groups were not statistically significant(P>0.05).The removal time of perineal drain tube in ELAPE group was significantly higher than that in APE group(P<0.05).There were no statistical significance in the exhaust time,defecation time,feeding fluid time,perineal drainage volume,hospitalization time and perineal wound thread removal time between two groups(P>0.05).All patients were followed up for 6 to 24 months,the distant metastasis rate and mortality rate in ELAPE group were significantly lower than those in APE group(P<0.01 and P<0.05),and there was no statistical significance in the local recurrence rate between two groups(P>0.05).Conclusions:Compared with the traditional APE,ELAPE reduces the amount of bleeding,positive circumferential resection margin,incidence rate of distant metastasis and death rate,significantly improves the short-term prognosis of patients with low rectal cancer,which is worthy of attention. -
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