Iwamura Takeshi, Hotokezaka Masayuki, Eto Tada-Aki, Taniguchi Tomotaka, Chijiiwa Kazuo
Department of Surgery 1, Miyazaki University School of Medicine, Miyazaki, Japan.
Dig Surg. 2006;23(1-2):32-7. doi: 10.1159/000093492. Epub 2006 May 23.
BACKGROUND/AIMS: Abdominoperineal resection (APR) is generally performed in the lithotomy position (LT-APR). The aim of this retrospective study was to evaluate the advantage of the right lateral (RL) position during the perineal phase of APR, in extended APR (ext-APR) that needed additional excision of the pelvic organs and sacrococcyx, and in total pelvic exenteration (TPE).
The present study is based on 50 patients observed from January 1993 to December 2004 (43 with primary rectal malignancy, 7 with recurrent cancer), who had undergone the following surgeries: LT-APR was carried out in 20 patients, RL-APR in 13, LT-ext-APR in 5, RL-ext-APR in 8, LT-TPE in 2 and RL-TPE in 2. Perioperative factors were compared between the LT and RL position in each operative procedure.
When RL-APR was compared with LT-APR, operative time (including the time to change the position) and the amount of operative blood loss were significantly less in RL-APR (mean +/- SE = 314 +/- 16 vs. 381 +/- 18 min, p = 0.0156 and 598 +/- 78 vs. 1,160 +/- 171 g, p = 0.0168, respectively). The blood loss and operative time were also significantly less in RL-ext-APR than in LT-ext-APR (1,060 +/- 170 vs. 3,590 +/- 1,270 g, p = 0.0277 and 353 +/- 31 vs. 488 +/- 41 min, p = 0.0219, respectively). The average blood loss and operative time were 4,190 g and 650 min in LT-TPE, and 1,450 g and 609 min in RL-TPE, respectively.
The RL position during the perineal phase following the abdominal phase in the LT position significantly decreases blood loss and operative time in APR and ext-APR.
背景/目的：腹会阴联合切除术（APR）通常在截石位（LT-APR）下进行。本回顾性研究的目的是评估在APR会阴阶段、需要额外切除盆腔器官和骶尾骨的扩大APR（ext-APR）以及全盆腔脏器清扫术（TPE）中，右侧卧位（RL）的优势。
本研究基于1993年1月至2004年12月期间观察的50例患者（43例原发性直肠恶性肿瘤，7例复发性癌症），这些患者接受了以下手术：20例患者进行了LT-APR，13例进行了RL-APR，5例进行了LT-ext-APR，8例进行了RL-ext-APR，2例进行了LT-TPE，2例进行了RL-TPE。比较了每种手术中LT位和RL位的围手术期因素。
当将RL-APR与LT-APR进行比较时，RL-APR的手术时间（包括体位改变时间）和术中失血量明显更少（平均±标准误=314±16对381±18分钟，p=0.0156；598±78对1160±171克，p=0.0168）。RL-ext-APR的失血量和手术时间也明显少于LT-ext-APR（1060±170对3590±1270克，p=0.0277；353±31对488±41分钟，p=0.0219）。LT-TPE的平均失血量和手术时间分别为4190克和650分钟，RL-TPE分别为1450克和609分钟。
在LT位腹部阶段后的会阴阶段采用RL位可显著减少APR和ext-APR的失血量和手术时间。
