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1、个体化经肛提肌外腹会阴联合切除术治疗低位进展期直肠癌的探索韩加刚王振军魏广辉高志刚杨勇翟志伟赵宝首都医科大学附属北京朝阳医院普通外科摘要：目的探讨个体化经肛提肌外腹会阴联合切除术(extmlevatorabdominoperinealexcision,ELAPE)治疗低位进展期直肠癌的疗效。方法2011年6月至2015年6月,在术前磁共振成像(magneticresonanceimaging,MRI)精准指导下，56例低位进展期直肠癌患者接受个体化ELAPEo观察肿瘤环周切缘、术中穿孔、术后合并症和局部复发情况
2、。结果术前50例(89.3%)患者接受新辅助治疗。无围术期死亡病例，术后常见合并症包括:会阴伤口感染(9/56,16.1%)＞性功能障碍(5/41,12.2%)、尿潴留(4/56,7.1%)和慢性会阴部疼痛(3/56,5.4%)o术后环周切缘(circumferentialresectionmargin,CRM)阳性3例(5.4%),术中肠管穿孔2例(3.6%)。平均随访35个月(12%个月)，局部复发2例(3.6%)o结论在新辅助治疗和术前MRI的精准指导下，在不影响手术根治性的前提下，个体化ELAPE是治疗
3、低位进展期直肠癌的安全可行技术。关键词：直肠癌;个体化;经肛提肌外腹会阴联合切除术;合并症;局部复发;作者简介：WangZhenjun,E-mail:wang3zj@sohu.com收稿日期：2017-10-16基金：国家高技术研究发展计划(863计划)(2015AA033602)ResuItsofindividualextralevatorabdominoperinealresectionforlocallyadvancedlowrectaicancerHanJiagangWangZhenjunWeiGuan
4、ghuiGaoZhigangYangYongZhaiZhiweiZhaoBaochengDepartmentofGeneralSurgery,BeijingChaoyangHosptial,CopitalMedicalUniversity;Abstract：ObjectiveToevaluatethesafetyandefficacyofindividualizedextralevatorabdominoperinealexcision(ELAPE)forlocallyadvancedlowrectalcanc
5、er.MethodsFifty-sixpatientswhounderwentindividualizedabdominoperinealresection(APR)basedonmagneticresonanceimaging(MRI)fromJune2011toJune2015wereevaluated.Themainoutcomemeasureswerecircumferentialresectionmargininvolvement,intraoperativeperforation,postopera
6、tivecomplications,andlocalrecurrence.ResuItsDuringthestudy,fiftypatients(89.3%)receivedpreoperativechemoradiotherap\Thecommoncomplicationsincludedperinealwoundinfection(9/56,16.1%),sexualdysfunction(5/41,12.2%),ufiwryretention(4/56,7.1%)andchronicperinealpa
7、in(3/56,5.4%)•Apositivecircumferentialresectionmargin(CRM)wasdemonstratedin3(5.4%)patients,andintraoperativeperforationsoccurredin2(3.6%)patient.Thelocalrecurrencewas3.6%atamedianfollow-upof35months(range,12一60months)•ConclusionWithadequatepreoperativechemor
8、adiotherap^^andMRIpreciseguideline,individualizedELAPEmightbearelativelysafeandfeasibleapproachforlocallyadvancedlowrectaicancerwithacceptableoncologicaloutcomes.Keyword：rectalcancer;individuali
