Department of Colorectal Surgery, Concord Hospital, Sydney, Australia.
Colorectal Dis. 2013 Jan;15(1):57-65. doi: 10.1111/j.1463-1318.2012.03167.x.
The study aimed to compare recent reports on standard and alternative methods of abdominoperineal excision for low rectal cancer regarding the rates of circumferential resection margin involvement and intra-operative bowel perforation.
Data on rates of margin involvement and perforation were obtained from eight recently published reports and also from a prospective registry of resections at Concord Hospital. Rates of these outcomes and their 95% confidence intervals were evaluated.
There was no evidence that extralevator abdominoperineal excision yielded significantly lower rates of resection margin involvement or intra-operative bowel perforation compared with standard abdominoperineal excision in six independent hospital- and population-based patient series. Abdominosacral resection of the rectum, on the other hand, did show significantly lower rates of these endpoints, albeit in selected patients.
The role of extralevator abdominoperineal excision and abdominosacral resection of the rectum should be investigated further in randomized controlled trials.
本研究旨在比较近期关于低位直肠癌经腹会阴切除的标准方法和替代方法的报告，以评估环周切缘受累和术中肠穿孔的发生率。
从最近发表的 8 份报告以及康科德医院的前瞻性切除术登记处获得了切缘受累和穿孔的发生率数据。评估了这些结果的发生率及其 95%置信区间。
在六项独立的医院和人群为基础的患者系列研究中，没有证据表明经肛会阴外切除术与标准经肛会阴切除术相比，在环周切缘受累或术中肠穿孔的发生率方面有显著降低。另一方面，经腹直肠腹会阴切除术虽然在特定患者中，但确实显示出这些终点的发生率显著降低。
在随机对照试验中，应进一步研究经肛会阴外切除术和经腹直肠腹会阴切除术的作用。
