Abdominoperineal excision of the rectum - An endangered operation
Abdominoperineal excision of the rectum - An endangered operation
复制标题
DOI：
10.1007/bf02055425
复制
发表时间：
1997-07-01
影响因子：
3.9
通讯作者：
Moran, BJ
中科院分区：
文献类型：
--
作者：
Heald, RJ;Smedh, RK;Moran, BJ
目的：本研究旨在通过将精确的全直肠系膜切除、低位吻合器技术和腔内灌洗相结合以防止植入，来测试保留括约肌的极端政策的有效性。方法：前瞻性地记录了136例距肛缘5 cm以下的FBR癌的手术，并进行了平均7.7(范围1-18)年的随访。前路切除105例(77%)，腹会阴切除31例(23%)。结果：前路切除105例，虽然腹会阴切除较少(31例)，但肿瘤学效果明显优于腹会阴切除。前切除和全直肠系膜切除术后6年局部复发率分别为1%和4%(n=100)，腹会切除分别为33%和47%(n=15和31)。在提肌水平以下仅观察到4例复发，其中3例发生在腹会切除的伤口，1例发生在姑息性切除后的吻合口。未发现坐骨直肠窝淋巴结转移病例。结论：在专门从事括约肌保护的单位中，从上至下精确的全直肠系膜切除术在肿瘤学上似乎优于腹会切除术。四分之三的直肠下端癌患者可以接受保括约肌手术，尽管在这种情况下暂时的功能障碍可能是谨慎的。腹会切除的伤口可能是会复发的先决条件，而会复发通常是由植入引起的。
PURPOSE: This study was undertaken to test the efficacy of an extreme policy of sphincter conservation by combining precise total mesorectal excision with low stapling techniques and endoluminal lavage to guard against implantation. METHODS: A total of 136 consecutive operations fbr cancer below 5 cm from the anal verge has been prospec tively documented and followed for a mean of 7.7 (range, 1-18) years. A total of 105 of the operations were anterior resections (77 percent), and 31 were abdominoperineal excisions (23 percent), RESULTS: The oncologic results in the 105 patients who underwent anterior resections appear greatly superior to those of the patients who underwent abdominoperineal excisions, although the number of abdominoperineal excisions was small (31). Actuarial local recurrence at six years for anterior resection and total mesorectal excision was 1 percent for 85 curative procedures and 4 percent for all cases (n = 100), compared with 33 and 47 percent for abdominoperineal excisions (n = 15 and 31). Only four recurrences were observed below the level of the levators, three in the wound of an abdominoperineal excision and one in a stapled anastomosis after a palliative excision. No cases of nodal metastasis in the ischiorectal fossa were observed. CONCLUSION: In a unit specializing in sphincter conservation, precise total mesorectal excision from above appears oncologically superior to abdominoperineal excision. Three-fourths of patients with carcinoma of the lower one-third of the rectum can be offered sphincter-conserving surgery, although temporary defunctioning is probably prudent in such cases. The wound of an abdominoperineal excision may be a prerequisite for perineal recurrence, which may often be caused by implantation.