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腹会阴联合切除术(abdominoperineal resection,APR)是低位直肠、肛管恶性肿瘤的标准术式。APR手术范围通常包括肛提肌、坐骨直肠窝脂肪和会阴皮肤,最主要的目的和原则是获得阴性的环周切缘。交界性保肛的病人应进行高质量的MRI评价,进行充分的术前计划,避免术中决策。近年来众多研究重新强调了肛提肌切除范围的重要性。对这种手术技巧的回顾以及重命名,如柱状APR或肛提肌外腹会阴联合切除术(ELAPE),使APR手术质量得到提高。APR可根据切除范围分为3类:(1)肛提肌内APR,即“传统”或“标准”APR;(2)ELAPE、柱状APR;(3)Miles APR、坐骨直肠窝切除APR。在高选择的病例中,APR联合多脏器切除,如精囊腺切除、阴道后壁切除等,有利于提高R0切除率,同时兼顾器官功能的保留。
Abdominoperineal resection (APR) is a standard procedure for low rectal and anal canal malignancies. APR surgical range usually includes levator ani muscle, ischial rectal fat and perineal skin, the main purpose and principle is to obtain a negative circumferential margin. Patients with borderline anal sphincter should undergo high-quality MRI evaluation and have adequate preoperative planning to avoid intraoperative decision-making. In recent years, many studies have re-emphasized the importance of levator ani muscle resection range. A review and renaming of this surgical technique, such as columnar APR or levator ani abdominoperineal excision (ELAPE), improves the quality of APR surgery. APR can be divided into 3 categories according to the resection scope: (1) APR in levator ani, which is “traditional” or “standard” APR; (2) ELAPE, columnar APR; APR removal. In highly selected cases, APR combined with multiple organ resection, such as seminal vesicle resection, vaginal wall resection, etc., is conducive to improving R0 resection rate, taking into account the retention of organ function.