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《個(gè)體化經(jīng)肛提肌外腹會(huì)陰聯(lián)合切除術(shù)治療低位進(jìn)展期直腸癌的探索.doc》由會(huì)員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在工程資料-天天文庫。
1、個(gè)體化經(jīng)肛提肌外腹會(huì)陰聯(lián)合切除術(shù)治療低位進(jìn)展期直腸癌的探索韓加剛王振軍魏廣輝高志剛楊勇翟志偉趙寶首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院普通外科摘要：目的探討個(gè)體化經(jīng)肛提肌外腹會(huì)陰聯(lián)合切除術(shù)(extmlevatorabdominoperinealexcision,ELAPE)治療低位進(jìn)展期直腸癌的療效。方法2011年6月至2015年6月,在術(shù)前磁共振成像(magneticresonanceimaging,MRI)精準(zhǔn)指導(dǎo)下，56例低位進(jìn)展期直腸癌患者接受個(gè)體化ELAPEo觀察腫瘤環(huán)周切緣、術(shù)中穿孔、術(shù)后合并癥和局部復(fù)發(fā)情況
2、。結(jié)果術(shù)前50例(89.3%)患者接受新輔助治療。無圍術(shù)期死亡病例，術(shù)后常見合并癥包括:會(huì)陰傷口感染(9/56,16.1%)＞性功能障礙(5/41,12.2%)、尿潴留(4/56,7.1%)和慢性會(huì)陰部疼痛(3/56,5.4%)o術(shù)后環(huán)周切緣(circumferentialresectionmargin,CRM)陽性3例(5.4%),術(shù)中腸管穿孔2例(3.6%)。平均隨訪35個(gè)月(12%個(gè)月)，局部復(fù)發(fā)2例(3.6%)o結(jié)論在新輔助治療和術(shù)前MRI的精準(zhǔn)指導(dǎo)下，在不影響手術(shù)根治性的前提下，個(gè)體化ELAPE是治療
3、低位進(jìn)展期直腸癌的安全可行技術(shù)。關(guān)鍵詞：直腸癌;個(gè)體化;經(jīng)肛提肌外腹會(huì)陰聯(lián)合切除術(shù);合并癥;局部復(fù)發(fā);作者簡(jiǎn)介：WangZhenjun,E-mail:wang3zj@sohu.com收稿日期：2017-10-16基金：國家高技術(shù)研究發(fā)展計(jì)劃(863計(jì)劃)(2015AA033602)ResuItsofindividualextralevatorabdominoperinealresectionforlocallyadvancedlowrectaicancerHanJiagangWangZhenjunWeiGuan
4、ghuiGaoZhigangYangYongZhaiZhiweiZhaoBaochengDepartmentofGeneralSurgery,BeijingChaoyangHosptial,CopitalMedicalUniversity;Abstract：ObjectiveToevaluatethesafetyandefficacyofindividualizedextralevatorabdominoperinealexcision(ELAPE)forlocallyadvancedlowrectalcanc
5、er.MethodsFifty-sixpatientswhounderwentindividualizedabdominoperinealresection(APR)basedonmagneticresonanceimaging(MRI)fromJune2011toJune2015wereevaluated.Themainoutcomemeasureswerecircumferentialresectionmargininvolvement,intraoperativeperforation,postopera
6、tivecomplications,andlocalrecurrence.ResuItsDuringthestudy,fiftypatients(89.3%)receivedpreoperativechemoradiotherap\Thecommoncomplicationsincludedperinealwoundinfection(9/56,16.1%),sexualdysfunction(5/41,12.2%),ufiwryretention(4/56,7.1%)andchronicperinealpa
7、in(3/56,5.4%)?Apositivecircumferentialresectionmargin(CRM)wasdemonstratedin3(5.4%)patients,andintraoperativeperforationsoccurredin2(3.6%)patient.Thelocalrecurrencewas3.6%atamedianfollow-upof35months(range,12一60months)?ConclusionWithadequatepreoperativechemor
8、adiotherap^^andMRIpreciseguideline,individualizedELAPEmightbearelativelysafeandfeasibleapproachforlocallyadvancedlowrectaicancerwithacceptableoncologicaloutcomes.Keyword：rectalcancer;individuali
