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随机对照临床试验：传统与柱状经腹会阴联合切除术治疗局部进展期低位直肠癌的比较

Randomized clinical trial of conventional versus cylindrical abdominoperineal resection for locally advanced lower rectal cancer.

机构信息

Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

出版信息

Am J Surg. 2012 Sep;204(3):274-82. doi: 10.1016/j.amjsurg.2012.05.001.

DOI:10.1016/j.amjsurg.2012.05.001

PMID:22920402

Abstract

BACKGROUND

An alternative treatment for low rectal cancer is the cylindrical technique. We aim to compare the outcomes of patients undergoing conventional abdominoperineal resection (APR) versus cylindrical APR.

METHODS

A prospective, randomized, open-label, parallel controlled trial was conducted between January 2008 and December 2010. Sixty-seven patients with T3-T4 low rectal cancer were identified during the study period (conventional n = 32, cylindrical n = 35).

RESULTS

Patients who received cylindrical APR had less operative time for the perineal portion (P < .001), larger perineal defect (P < .001), less intraoperative blood loss (P = .001), larger total cross-sectional tissue area (P < .001), similar total operative time (P = .096), and more incidence of perineal pain (P < .001). The local recurrence of the cylindrical APR group was improved statistically (P = .048).

CONCLUSIONS

Cylindrical APR in the prone jackknife position has the potential to reduce the risk of local recurrence without increased complications when compared with conventional APR in the lithotomy position for the treatment of low rectal cancer.

摘要

背景

对于低位直肠癌的一种替代治疗方法是圆柱技术。我们旨在比较接受传统经腹会阴切除术（APR）与圆柱 APR 的患者的结局。

方法

一项前瞻性、随机、开放标签、平行对照试验于 2008 年 1 月至 2010 年 12 月进行。研究期间确定了 67 例 T3-T4 低位直肠肿瘤患者（常规组 n = 32，圆柱组 n = 35）。

结果

接受圆柱 APR 的患者会阴部手术时间更短（P <.001），会阴缺损更大（P <.001），术中出血量更少（P =.001），总横截面积更大（P <.001），总手术时间相似（P =.096），会阴疼痛发生率更高（P <.001）。圆柱 APR 组的局部复发率得到了统计学上的改善（P =.048）。