Ma Jun, Tang Dai-Bin, Tang Yu-Quan, Wang Da-Tian, Jiang Peng, Zhang Ya-Ming
Department of General Surgery, Anqing Municipal Hospital, Anqing 246000, Anhui Province, China.
Department of Anesthesiology, Anqing Municipal Hospital, Anqing 246000, Anhui Province, China.
World J Gastrointest Surg. 2024 Aug 27;16(8):2528-2537. doi: 10.4240/wjgs.v16.i8.2528.
The abdominal perineal resection (APR), historically referred to as Mile's procedure, stands as a time-honored surgical intervention for rectal cancer management. Advancements in surgical techniques and the advent of neoadjuvant therapies have significantly improved the rate of sphincter preservation among patients afflicted with rectal cancer, including those with ultralow rectal cancer. Despite these improvements, APR maintains its irreplaceable role in the clinical landscape, particularly for cases involving low rectal cancer with encroachment on the external anal sphincter or levator ani muscles. Optimal perineal exposure stands as a pivotal phase in APR, given that the precision of this maneuver is directly correlated with both the safety of the surgery and the patient's subsequent long-term prognosis.
To evaluate the value of Lone-Star retractor (LSR) perineal exposure method in the treatment for laparoscopic APR of rectal cancer.
We reviewed the records of 38 patients with rectal cancer at Anqing Municipal Hospital from January 2020 to December 2023, including 20 patients who underwent the APR procedure with a LSR perineal exposure method (LSR group) and 18 patients who underwent the APR procedure with a conventional perineal exposure method (control group). In the LSR group, following incision of the skin and subcutaneous tissue, the LSR was placed and dynamically adjusted according to the surgical plane to fully expose the perineal operative field.
A total of 38 patients underwent laparoscopic APR, none of whom were found to have distant metastasis upon intraoperative exploration. Perineal blood loss, the postoperative hospital stays and the wound pain scores in the LSR group were significantly lower than those in the control group. A single surgeon completed the perineal operation significantly more often in the LSR group than in the control group ( < 0.05). The incidence of infection the perineal incision in the LSR group was significantly lower than that in the control group ( < 0.05). No cases of distant metastasis or local recurrence were found among the patients at the postoperative follow-up.
The application of the LSR technique might be helpful for performing perineal exposure during APR for rectal cancer and could reduce the incidence of perineal complications, shorten the postoperative hospital stay, improve postoperative pain, and allow one surgeon to perform the perineal operation.
腹会阴联合切除术（APR），历史上称为迈尔斯手术，是一种治疗直肠癌的历史悠久的外科手术。手术技术的进步和新辅助治疗的出现显著提高了直肠癌患者（包括超低位直肠癌患者）的保肛率。尽管有这些进步，APR在临床领域仍保持着不可替代的作用，特别是对于涉及侵犯肛门外括约肌或肛提肌的低位直肠癌病例。鉴于该操作的精确性与手术安全性和患者随后的长期预后直接相关，最佳的会阴暴露是APR中的关键阶段。
评估孤星牵开器（LSR）会阴暴露方法在直肠癌腹腔镜APR治疗中的价值。
我们回顾了2020年1月至2023年12月安庆市立医院38例直肠癌患者的记录，其中20例采用LSR会阴暴露方法行APR手术（LSR组），18例采用传统会阴暴露方法行APR手术（对照组）。在LSR组中，切开皮肤和皮下组织后，放置LSR并根据手术平面动态调整，以充分暴露会阴手术视野。
共有38例患者接受了腹腔镜APR，术中探查均未发现远处转移。LSR组的会阴失血量、术后住院时间和伤口疼痛评分均显著低于对照组。LSR组由单一外科医生完成会阴手术的频率明显高于对照组（<0.05）。LSR组会阴切口感染发生率明显低于对照组（<0.05）。术后随访患者中未发现远处转移或局部复发病例。
LSR技术的应用可能有助于在直肠癌APR手术中进行会阴暴露，可降低会阴并发症的发生率，缩短术后住院时间，改善术后疼痛，并允许单一外科医生进行会阴手术。
