柱状经腹会阴直肠癌联合切除术的初步研究
高志刚;杨增辉;王振军;魏广辉;李敏哲;杜燕夫
【期刊名称】《肿瘤研究与临床》 【年(卷),期】2009(021)008
【摘要】目的 报道柱状经腹会阴直肠癌切除术和使用人类脱细胞真皮基质(HADM)进行盆底重建的初步应用结果.方法 北京朝阳医院普外科自2008年1月至2009年4月,采用柱状经腹会阴直肠癌切除术治疗13例低位直肠癌.腹部操作直肠系膜的分离停止于肛提肌附着盆壁的平面.会阴操作采用俯卧折刀位,在进入盆腔之前环周解剖出肛提肌.切除尾骨和第五骶骨,切开Waldeyer筋膜进入盆腔,从后向前切断两侧肛提肌.在会阴横肌的后方切断盆底肌纤维并将直肠和肛管完整切除,标本呈圆柱状.盆底缺损使用HADM重建.结果 所有患者无直肠穿孔,病理示环周切缘阴性.平均随访8个月,会阴伤口无裂开、膨出和疝的发生.会阴伤口感染1例,无症状血清肿1例,会阴疼痛3例,短期尿潴留5例.结论 柱状经腹会阴直肠癌切除术可以降低Miles手术环周切缘阳性率和肠穿孔率,HADM盆底重建可以降低手术难度,不增加手术并发症的发生.%Objective To report the preliminary result of cylindrical abdominoperineal resection (cylindrical APR) and pelvic reconstruction with human acellular dermal matrix (HADM). Methods Cylindrical APR was performed in 13 consecutive patients with advanced very low rectal cancer between January 2008 and April 2009. The mesorectum was not dissected off the levator muscles at abdominal part of the operation, the perineal part of the operation was done in the prone position. The levator muscles were
柱状经腹会阴直肠癌联合切除术的初步研究
