检索历史 清除

针对传统腹会阴联合切除术治疗直肠癌术后局部复发率较高的缺点,近年来提出了柱状腹会阴联合切除术(CAPR)的手术方法,也称为经肛提肌外腹会阴联合切除术.从目前研究来看,该术式可以降低直肠癌手术的环周切缘阳性率和肿瘤穿孔率,降低术后局部复发率,从而可能提高患者的生存率.随着研究的深入,出现了一些热点问题,如盆底的重建方法、会阴部手术操作的体位、腹腔镜技术的联合应用、术后的会阴疼痛以及术后泌尿生殖神经损伤的并发症等.在临床实践和解剖学研究的基础上提出的个体化CAPR技术有望在保证根治性的前提下,减少患者创伤,降低术后并发症的发生.

Cylindrical abdominoperineal resection (CAPR),also known as extralevator abdominoperineal excision (ELAPE),has been described as a method for improving the outcome of APR for advanced low rectal cancer,probably because of more pelvic dissection and less positive circumferential resection margin (CRM).Recently,there have been some hot issues associated with CAPR/ELAPE,such as pelvic floor reconstruction methods, prone or lithotomy positioning during pelvic procedure, postoperative chronic perineal pain,postoperative sexual and urinary nerves damage,etc.Individual cylindrical procedure based on clinical and anatomic research may be as effective as CAPR/ELAPE while minimizing the operative trauma and the damage to the nerves of the genital and urinary organs.