Department of General Surgery, Anqing Municipal Hospital, No. 352, Ren-Ming Road, Anqing, 246000, Anhui Province, P.R. China.
Department of Anesthesiology, Anqing Municipal Hospital, Anqing, 246000, P.R. China.
BMC Surg. 2024 May 20;24(1):163. doi: 10.1186/s12893-024-02453-9.
Abdominal perineal resection (APR) of rectal cancer, also known as Mile's procedure, is a classic procedure for the treatment of rectal cancer. Through the improvement of surgical skills and neoadjuvant therapy, the sphincter-preserving rate in rectal cancer patients has improved, even in patients with ultralow rectal cancer who underwent APR in the past. However, APR cannot be completely replaced by low anterior resection (LAR) in reality. APR still has its indications, when the tumor affects the external sphincter, etc. Good perineal exposure in APR is difficult and can seriously affect surgical safety and the long-term prognosis.
We reviewed the records of 16 consecutive patients with rectal cancer who underwent APR at Anqing Municipal Hospital from January 2022 to April 2023, including 11 males and 5 females, with an average age of 64.8 ± 10.3 years. The perineal operation was completed with the Lone-Star® retractor-assisted (LSRA) exposure method. After incising the skin and subcutaneous tissue, a Lone-Star® retractor was placed, and the incision was retracted in surrounding directions with 8 small retractors, which facilitated the freeing of deep tissues. We dynamically adjusted the retractor according to the plane to fully expose the surgical field.
All 16 patients underwent laparoscopic-assisted APR successfully. Thirteen procedures were performed independently by a single person, and the others were completed by two persons due to intraoperative arterial hemostasis. All specimens were free of perforation and had a negative circumferential resection margin (CRM). Postoperative complications occurred in 4 patients, including urinary retention in 1 patient, pulmonary infection in 1 patient, intestinal adhesion in 1 patient and peristomal dermatitis in 1 patient, and were graded as ClavienDindo grade 3 or lower and cured. No distant metastasis or local recurrence was found for any of the patients in the postoperative follow-up.
The application of the LSRA exposure method might be helpful for perineal exposure during APR for rectal cancer, which could improve intraoperative safety and surgical efficiency, achieve one-person operation, and increase the comfort of operators.
直肠癌腹会阴联合切除术（APR），又称 Miles 手术，是治疗直肠癌的经典术式。通过手术技术的提高和新辅助治疗，直肠癌患者的保肛率得到了提高，即使是过去接受 APR 的超低位直肠癌患者也是如此。然而，在现实中，APR 并不能完全被低位前切除术（LAR）取代。APR 仍有其适应证，如肿瘤累及肛门外括约肌等。APR 中的良好会阴显露较为困难，会严重影响手术安全性和长期预后。
回顾性分析 2022 年 1 月至 2023 年 4 月安庆市立医院收治的 16 例行 APR 的直肠癌患者的临床资料，其中男 11 例，女 5 例；年龄 64.8±10.3 岁。采用 Lone-Star®牵开器辅助（LSRA）暴露法完成会阴手术。切开皮肤及皮下组织后，置入 Lone-Star®牵开器，用 8 个小牵开器向周围方向牵拉切口，以游离深部组织。根据手术平面动态调整牵开器，充分暴露手术野。
16 例患者均成功完成腹腔镜辅助 APR。13 例由单人独立完成，其余 3 例因术中动脉止血需要由 2 人共同完成。所有标本均无穿孔，且环周切缘（CRM）均为阴性。术后 4 例患者出现并发症，其中 1 例发生尿潴留，1 例发生肺部感染，1 例发生肠粘连，1 例发生肛周皮炎，均为 ClavienDindo 分级 3 级及以下，经治疗后治愈。术后随访患者均未发现远处转移或局部复发。
LSRA 暴露法应用于直肠癌 APR 中有助于会阴显露，可提高术中安全性和手术效率，实现单人操作，增加术者舒适度。
