Division of Surgery, School of Graduate Entry Medicine and Health, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK,
Tech Coloproctol. 2014 Jun;18(6):571-7. doi: 10.1007/s10151-013-1107-7. Epub 2014 Jan 17.
Extra-levator abdominoperineal excision of the rectum (ELAPER) for low rectal cancer is used to avoid the adverse oncological outcomes of inadvertent perforation and a positive circumferential resection margin associated with the conventional APER technique. This wider excision creates a large defect requiring pelvic floor reconstruction, and there is still controversy regarding the best method of closure. The aim of this study is to present outcomes of biological mesh pelvic floor reconstruction following ELAPER.
Prospective data on consecutive patients having ELAPER for low rectal cancer at a single UK institution between October 2008 and March 2013 were collected. The perineum was reconstructed using a biological mesh and the short-term outcomes were evaluated, focusing particularly on perineal wound complications and perineal hernias.
Thirty-four patients were included [median age 62 years, range 40-72 years, 27 males (79 %)]. The median operative time was 248 min (range 120-340 min). The median length of hospital stay was 9 days (range 4-20 days). There were three perineal complications (9 %) requiring surgical intervention, but no meshes were removed. There were no perineal hernias. The median length of follow-up was 21 months (range 1-54 months). The overall mortality was 9 % from distant metastases.
Our series adds to the increasing evidence that good outcomes can be achieved for pelvic floor reconstruction with biological mesh following ELAPER without the additional use of myocutaneous flaps. The low serious complication rate, good outcomes in perineal wound healing and the absence of perineal hernias demonstrates that this is a safe and feasible procedure.
直肠低位前切除术中行额外的会阴-腹部-会阴切除术（ELAPER）是为了避免由于常规 APER 技术导致的直肠穿孔和环周切缘阳性的不良肿瘤学结局。这种更广泛的切除会导致较大的缺陷，需要进行盆底重建，而对于最佳的闭合方法仍存在争议。本研究旨在介绍 ELAPER 术后生物补片盆底重建的结果。
收集了 2008 年 10 月至 2013 年 3 月期间在英国一家机构连续接受 ELAPER 治疗的低位直肠癌患者的前瞻性数据。会阴采用生物补片进行重建，并评估了短期结果，特别关注会阴伤口并发症和会阴疝。
纳入了 34 例患者[中位年龄 62 岁，范围 40-72 岁，男性 27 例（79%）]。中位手术时间为 248 分钟（范围 120-340 分钟）。中位住院时间为 9 天（范围 4-20 天）。有 3 例会阴并发症（9%）需要手术干预，但没有补片被移除。无会阴疝。中位随访时间为 21 个月（范围 1-54 个月）。总死亡率为 9%，死于远处转移。
我们的系列研究增加了越来越多的证据，表明在不额外使用肌皮瓣的情况下，ELAPER 术后使用生物补片进行盆底重建可以获得良好的结果。低严重并发症率、会阴伤口愈合良好且无会阴疝表明，这是一种安全可行的手术方法。
