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目的总结低位直肠癌采用柱状经腹会阴切除术(APR)的应用体会。方法徐州医学院附属医院普通外科于2010年1月至2013年7月期间采用柱状APR治疗22例低位直肠癌患者(柱状APR组),并与同期行传统APR治疗的35例患者(传统APR组)进行对比,分析术中、术后和随访的各项指标。结果与传统APR组比较,柱状APR组的环周切缘阳性率及术中穿孔率明显降低〔4.55%(1/22)比34.29%(12/35)和4.55%(1/22)比31.43%(11/35)〕,差异有统计学意义(P<0.05);2组手术时间、术中出血量、并发症发生率比较,差异无统计学意义(P>0.05)。术后随访3~30个月(平均21个月),柱状APR组无肿瘤复发及远处转移患者,未见死亡病例;传统APR组出现盆底局部复发4例,远处转移3例,死亡2例。2组局部复发、远处转移及死亡率比较差异均无统计学意义(P>0.05)。结论柱状APR可以切除更多的肿瘤周围组织,降低环周切缘阳性率,减少术中肠穿孔的发生,降低局部复发。
Objective To summarize the experience of using columnar transabdominal perineal excision (APR) for low rectal cancer. Methods A total of 22 patients with low rectal cancer (columnar APR group) undergoing columnar APR were recruited from January 2010 to July 2013 in General Surgery Hospital, Xuzhou Medical College Affiliated Hospital, and 35 patients (conventional APR group) ) Were compared, analysis of intraoperative, postoperative and follow-up of the indicators. Results Compared with the traditional APR group, the positive rate of peri-annular margins and perforation rate in the columnar APR group were significantly lower than those in the conventional APR group (4.55% (1/22) vs 34.29% (12/35) and 4.55% (1/22) vs 31.43 % (11/35)], the difference was statistically significant (P <0.05). There was no significant difference in operative time, intraoperative blood loss and complication rate between the two groups (P> 0.05). There were no cases of death in the patients with postoperative AP in the group of APR without recurrence and distant metastasis. In the traditional APR group, there were 4 cases of pelvic floor recurrence, 3 cases of distant metastasis and 3 cases of death 2 cases. There was no significant difference in the local recurrence, distant metastasis and mortality between the two groups (P> 0.05). Conclusion The columnar APR can excise more tumor surrounding tissues, reduce the positive rate of circumferential margins, reduce the occurrence of intraoperative intestinal perforation and reduce the local recurrence.