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目的:探讨肛提肌外腹会阴联合切除术治疗低位直肠癌预防肿瘤局部复发的临床效果。方法:回顾性分析2011年01月至2014年01月我院行手术治疗的低位直肠癌患者临床病历资料,按照手术方式分为肛提肌外腹会阴联合切除术(观察组)和传统经腹会阴联合直肠癌切除术(对照组),比较两组患者的近期临床疗效和术后1年、2年局部肿瘤复发率。结果:两组手术时间、术中出血量、骶前引流管引流时间以及住院时间比较,差异无统计学意义(P>0.05)。观察组术中穿孔率、术后环周切缘阳性率低于对照组,会阴部切口延迟愈合、切口感染发生率高于对照组,差异有统计学意义(P<0.05),两组术后肠梗阻、泌尿生殖系统障碍、会阴部慢性疼痛发生率差异无统计学意义(P>0.05)。术后平均随访时间(1.5±0.7)年,观察组1年、2年局部肿瘤复发率为9.09%、28.26%,分别低于对照组的21.21%、43.48%,差异有统计学意义(P<0.05)。结论:肛提肌外腹会阴联合切除术治疗低位直肠癌的近期疗效好,安全性高,可明显降低术后1年、2年局部肿瘤复发率。
Objective: To investigate the clinical effect of levator ani external perineum combined with resection for the treatment of low rectal cancer to prevent local tumor recurrence. Methods: The clinical data of patients with low rectal cancer who underwent surgical treatment in our hospital from January 2011 to January 2014 were retrospectively analyzed. According to the surgical methods, the patients were divided into extra-abdominal perineal resection (observation group) and traditional abdomen Perineal resection of colorectal cancer (control group), the two groups of patients with short-term clinical efficacy and 1 year, 2 years local tumor recurrence rate. Results: There was no significant difference in operative time, intraoperative blood loss, drainage time of presacral drainage tube and hospitalization time (P> 0.05). The perforation rate of the observation group and the positive rate of the circumferential margin after operation were lower than those of the control group. The perineal incision delayed healing and the incision infection rate was higher than that of the control group (P <0.05) The incidence of intestinal obstruction, urogenital disorders and perineal chronic pain had no significant difference (P> 0.05). The mean postoperative follow-up time was (1.5 ± 0.7) years. The local tumor recurrence rates at 1 year and 2 years in the observation group were 9.09% and 28.26%, which were significantly lower than those in the control group (21.21% and 43.48%, P < 0.05). Conclusion: The treatment of low rectal cancer with levator ani extraperitoneal perineal resection has a good short-term curative effect and high safety. It can significantly reduce the local tumor recurrence rate after 1 year and 2 years.