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目的 :探讨腹腔镜经盆腔途径肛提肌外腹会阴联合直肠切除术(ELAPE)治疗低位进展期直肠癌的安全性及可行性。方法:回顾性分析2013年8月—2015年4月徐州医学院附属医院胃肠外科30例低位进展期直肠癌患者行腹腔镜经盆腔途径ELAPE手术,术中根据肿瘤侵犯肛提肌程度,经盆腔途径直视下个体化切除肛提肌范围,所有患者常规经腹关闭盆底腹膜,会阴部操作不改变体位,未行盆底重建。记录患者手术情况,术后早期并发症及临床效果。结果:全部患者手术操作顺利,无术中并发症及中转开腹,所有标本切除肛提肌均附于远端直肠系膜,环周切缘均为阴性,平均手术时间(193.0±31.5)min,术中平均出血量(90.5±24.2)m L。术后随访3~18个月,未见肿瘤复发及转移。结论:腹腔镜经盆腔途径ELAPE术治疗低位进展期直肠癌是可行的,操作简单,创伤小,手术时间短,近期并发症少。
Objective: To investigate the safety and feasibility of laparoscopic pelvic approach levator ani external perineum combined with rectal resection (ELAPE) in the treatment of low-grade advanced rectal cancer. Methods: A retrospective analysis of 30 patients with low-grade advanced rectal cancer undergoing laparoscopic pelvic approach ELAPE surgery from August 2013 to April 2015 in Xuzhou Medical College Affiliated Hospital of Gastrointestinal Surgery. According to the extent of tumor invasion of levator ani muscle, Pelvic approach under the scope of individualized resection of the levator ani, all patients routinely closed pelvic peritoneum, perineal operation does not change the position, not pelvic floor reconstruction. Record the patient’s surgery, early postoperative complications and clinical effect. Results: All the patients operated smoothly without any intraoperative complications and transit laparotomy. All the specimens were allotted to the distal mesorectum and the margins were all negative. The average operative time was (193.0 ± 31.5) min, Mean intraoperative blood loss (90.5 ± 24.2) m L. All cases were followed up for 3 to 18 months. No tumor recurrence and metastasis were found. Conclusion: Laparoscopic treatment of low-grade advanced colorectal cancer by pelvic approach ELAPE is feasible, simple operation, small trauma, short operative time and few recent complications.