Chi Pan, Chen Zhi-fen, Lin Hui-ming, Lu Xing-rong, Huang Ying
Department of Colorectal Surgery, Fujian Medical University, Fuzhou, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2012 Jun;15(6):589-93.
To evaluate the safety and feasibility of laparoscopic cylindrical abdominoperineal resection.
Six patients with rectal adenocarcinoma within 3 cm above the anal verge underwent laparoscopic cylindrical abdominoperineal resection. Transabdominal levator transaction was performed laparoscopically, with no position change during the perineal operation. Pelvic reconstruction was achieved using human acellular dermal matrix mesh in 3 patients.
All the procedures were successfully performed without any intraoperative complications, laparoscopy-associated complications, or conversion to the open approach. The mean operation time was 186.7 minutes and intraoperative blood loss was 101.7 ml. All the specimens had a cylindrical shape with levator muscles attached to the mesorectum and circumferential margins were all negative. No adverse incidence followed the pelvic reconstruction using human acellular dermal matrix mesh.
Laparoscopic transabdominal transection of the levator muscles without position change and pelvic floor reconstruction with human acellular dermal matrix mesh is feasible. This procedure simplifies cylindrical abdominoperineal resection which is aggressively invasive and technically complicated. The oncologic outcomes are acceptable and complications are less.
评估腹腔镜柱状腹会阴联合切除术的安全性和可行性。
对6例距肛缘3 cm以内的直肠腺癌患者行腹腔镜柱状腹会阴联合切除术。经腹腹腔镜下切断提肛肌，会阴手术期间不改变体位。3例患者使用人脱细胞真皮基质网进行盆底重建。
所有手术均成功完成，无术中并发症、腹腔镜相关并发症或中转开腹。平均手术时间为186.7分钟，术中出血量为101.7 ml。所有标本均呈柱状，提肛肌附着于直肠系膜，切缘均为阴性。使用人脱细胞真皮基质网进行盆底重建后未出现不良事件。
腹腔镜下不改变体位经腹切断提肛肌并用人脱细胞真皮基质网进行盆底重建是可行的。该手术简化了具有侵袭性且技术复杂的柱状腹会阴联合切除术。肿瘤学结局可接受，并发症较少。
