Yeovil District Hospital, Yeovil, UK.
Colorectal Dis. 2012 Sep;14(9):1052-9. doi: 10.1111/j.1463-1318.2012.03169.x.
An improvement in oncological outcome has been reported following an extralevator approach to abdominoperineal excision (ELAPE) for low rectal carcinoma. A larger perineal defect following ELAPE and the impact of neoadjuvant radiotherapy are sources of considerable morbidity for patients. We report an evidence-based systematic review of published data on the outcome of perineal reconstruction following ELAPE for low rectal carcinoma, comparing the use of tissue flap and biological mesh techniques.
A literature search was performed of electronic databases including the Medline, Embase and Scopus databases (1995-2011). Studies describing outcomes relating to the perineum following ELAPE were included for review.
Eleven small cohort studies reported the outcome relating to the perineum following ELAPE. Pooled-analysis of 255 combined patients undergoing flap repair and 85 undergoing biological mesh repair showed no significant difference in the rates of perineal wound complications or perineal hernia formation.
There is little information on the optimal technique of perineal wound closure following ELAPE. With the limited data available, there was no significant difference in complication rates between biological mesh and flap repair. There is a need for high-quality prospective trials to compare methods of reconstruction to determine the long-term results, quality of life and function.
经腹会阴联合切除（ELAPE）治疗低位直肠癌的会阴侧切入路（ELAPE）可改善肿瘤学预后。ELAPE 后会阴缺损较大，新辅助放疗的影响是患者发病率高的原因。我们报告了一项基于证据的系统评价，对 ELAPE 治疗低位直肠癌后会阴重建的已发表数据进行了综述，比较了组织瓣和生物网技术的应用。
对包括 Medline、Embase 和 Scopus 数据库在内的电子数据库进行了文献检索（1995-2011 年）。纳入描述 ELAPE 后会阴相关结局的研究进行综述。
11 项小队列研究报告了 ELAPE 后会阴的结局。255 例接受皮瓣修复和 85 例接受生物网修复的患者的汇总分析显示，会阴伤口并发症或会阴疝形成的发生率无显著差异。
关于 ELAPE 后会阴伤口闭合的最佳技术几乎没有信息。根据现有有限的数据，生物网和皮瓣修复的并发症发生率无显著差异。需要高质量的前瞻性试验来比较重建方法，以确定长期结果、生活质量和功能。
