腹会阴直肠癌柱状切除术经改良后治疗低位直肠癌的30例临床效果分析

摘要目的：探讨分析改良后的腹会阴直肠癌柱状切除术治疗低位直肠癌，降低局部复发率的临床效果。方法：回顾性分析2010年1月至2012年6月入住我院并采用改进后的腹会阴直肠癌柱状切除术（CAPR）治疗低位直肠癌的患者30例，男性20例，女性10例，年龄为57＋3．8岁，肿瘤分期为T3-T4。结果：采用改进的CAPR能切除更多远端直肠周围组织；切除标本呈柱状；30例均无术中肠穿孔；会阴切口均Ⅰ期愈合；1例发生会阴血清肿；30倒均无盆底会阴疝形成；术后30例直肠环周切缘均无癌残留；术后平均随访2．1±3．1个月，均无局部复发。结论：经改进的腹会阴直肠癌柱状切除术不仅降低了手术的操作难度，扩大了直肠周围的切除范围，降低了术中直肠穿孔率和环周切缘阳性率，从而降低术后局部复发率，该术式值得在临床上进一步推广。

The Clinical Analysis about the Application of Modified Cylindrical Abdominoperineal Resection on the Low-set Rectal Cancers with 30 cases

Objective： To analyze the clinical effects of the modified cylindrical abdominoperineal resection （CAPR） on the treatment of low-set rectal cancers. Methods： 30 cases with advanced low-set rectal cancer who had been in our hospital and carried on the operation by modified CAPR, from January 2010 to June 2012 were selected to be analyzed retrospectively, including 10 females and 20 males, with the average age of 57＋ 3.8, tumor staging at T3 to T4. Results： With the improved CAPR, more tissues around the distal rectum could be removed. The specimens presented the columnar. There was no bowel perforation of 30 cases when operating. The incision ofperineum cured at stage I. Only one case reflected perineum seroma. There was no perineal hernia forming on the pelvic and no postoperative residual on the edge of rectal circumference. The local recurrences of the patients haven＇t been found after following up for 2.1 ＋ / - 3.1 months on the average. Conclusion： The modified abdominal perineal resection for rectal cancer could not only reduce the operating difficulties, but also expand range of resection around the rectum. CAPR could reduce the rate of intraoperative colon perforation and the positive rate of the cutting circumference, therefore it could reduce the rate of postoperative recurrences. It is worthy of popularizing in clinical fields.