Surgical Department P, Aarhus University Hospital, Aarhus, Denmark.
Dis Colon Rectum. 2011 Jun;54(6):711-7. doi: 10.1007/DCR.0b013e3182163c89.
Extralevator abdominoperineal excision for low rectal cancer includes resection of the pelvic floor as a part of the operative technique to reduce the risk of tumor-involved section margins.
This study aimed to compare perineal defect reconstruction with a fasciocutaneous gluteal flap vs biological mesh regarding healing and occurrence of perineal hernia.
Retrospective review of medical records comparing surgical methods during 2 consecutive periods.
Tertiary care university medical center (Colorectal Section, Surgical Department P, Aarhus University Hospital, Denmark).
Patients with low rectal cancer who underwent extralevator abdominoperineal excision from December 2005 through October 2008 were included.
The perineum was reconstructed with a fasciocutaneous gluteal flap in the first period and with a biological mesh in the second period.
We assessed rates of perineal wound infection requiring surgical intervention and perineal hernia diagnosed by clinical examination.
The study comprised 57 patients: 33 patients with gluteal flap and 24 with biological mesh reconstruction. Perineal hernia developed in 7 (21%) patients in the gluteal flap group and in none (0%) of the patients in the mesh group (P < .01). Median follow-up was 3.2 (1.7-4.3) years for gluteal flap and 1.7 (0.4-2.2) years for biologic mesh. All hernias occurred within the first postoperative year (median, 6 months; range, 1-12 months). Infectious complications were seen in 2 patients (6%) with a gluteal flap and in 4 patients (17%) with mesh repair (P = .26). After 3 months, all patients were completely healed except for 1 patient in each group with a persistent perineal sinus. The median (range) hospital stay was 14 (8-23) days in the flap group and 9 days (6-35) in the mesh group (P < .05).
This was a nonrandomized retrospective observational study comparing 2 methods used in different time periods.
We recommend biological mesh reconstruction of the pelvic floor after extralevator abdominoperineal resection because this method can achieve a high healing rate with an acceptable risk of infection, a low hernia rate, and a shorter hospital stay without donor-site morbidity.
低位直肠癌的经腹会阴联合切除包括切除骨盆底作为手术技术的一部分，以降低肿瘤累及部分边缘的风险。
本研究旨在比较臀外侧皮瓣与生物网片修复会阴缺陷在会阴愈合和会阴疝发生方面的差异。
回顾性分析连续两个时期的病历，比较手术方法。
丹麦奥胡斯大学医院（丹麦）肛肠外科 P 科三级保健大学医疗中心。
2005 年 12 月至 2008 年 10 月期间接受经腹会阴联合切除的低位直肠癌患者。
第一阶段采用臀外侧皮瓣，第二阶段采用生物网片进行会阴重建。
评估需要手术干预的会阴伤口感染率和临床检查诊断的会阴疝发生率。
本研究共纳入 57 例患者：33 例采用臀外侧皮瓣，24 例采用生物网片重建。臀外侧皮瓣组有 7 例（21%）发生会阴疝，而生物网片组无一例（0%）发生（P <.01）。臀外侧皮瓣组的中位随访时间为 3.2（1.7-4.3）年，生物网片组为 1.7（0.4-2.2）年。所有疝均发生在术后 1 年内（中位数，6 个月；范围，1-12 个月）。臀外侧皮瓣组有 2 例（6%）和生物网片组有 4 例（17%）患者发生感染性并发症（P =.26）。3 个月后，除两组各有 1 例患者仍存在持续性会阴窦道外，其余患者均完全愈合。皮瓣组的中位（范围）住院时间为 14（8-23）天，网片组为 9 天（6-35）天（P <.05）。
这是一项非随机回顾性观察研究，比较了不同时期使用的 2 种方法。
我们建议在经腹会阴联合切除后使用生物网片重建骨盆底，因为这种方法可以实现高愈合率，感染风险可接受，疝发生率低，且无供区并发症，住院时间短。
