【作者】 陈小岚； 黄志恒； 郑凯； 徐敏； 刘民生； 盛光； 唐远志； 王成友；

【机构】 深圳市第二人民医院胃肠、肛肠外科；

【摘要】 目的探讨肛管直肠癌会阴切除术(PR)技术改进的方法和临床应用价值。方法对279例腹会阴联合根治术 (APR)患者临床资料进行回顾性分析,其中126例常规手术组(对照组),按传统APR手术方法进行会阴切除术, 153例为会阴切除技术改进组,技术改进包括切口设计,手术入路,止血方法,盆底会阴重建及引流技术等．结果对所有病人进行一年以上随访,对照组术中术后大出血14例(11．1％),死亡1例;切破肠壁27例(21．4％),其中切破肿瘤19例(15．1％),输尿管损伤4例(3．1％),前列腺损伤11例(8．7％),后尿道损伤5例(3．9％),会阴切口延迟愈合56例(44．4％),会阴疝3例(1．9％),局部复发16例(12．7％)。技术改进组术中术后大出血5例(3．2％), 无手术死亡,切破肠壁7例(4．5％),其中切破肿瘤5例(3．2％),无输尿管损伤,前列腺损伤4例(2．6%),无后尿道损伤,会阴切口延迟愈合13例(8．5％),局部复发9例(5．8％)。二组并发症发生率比较有显著性差异(P<0．05)．结论 PR技术改进可减少各种并发症的发生。更多还原

【Abstract】 Objective To discuss the reason of the adverse complications of Mile’ s operation(Abdominal Perineal Resection, APR) and to discuss the technical difficulty and progressive resolusion. Methods To perform reverse clinical analysis to 269 patients who were carried APR. Results There are 86 cases occurring adverse complications among total 269 cases which accouting for 32%. There were 15 cases (5.6%) occuring bleeding because of PR which conclude 7 cases anterior-saccral huge bleeding (one case die), 5 cases perineal catherdral tube continuous bleeding and 3 cases carried operation for bleeding within 24 hours. There were 32 cases (11.9%) intestine desruption, 24 cases (8.9%) tumor desruption. There were 4 cases (1.5%) injuring ureteral tube, 5 cases (1.8%) injuring posterial uteral -tube. There were 68 cases (25.2%) with perineal hydration, 57 cases (21.2%) with perineal desruption, 47 cases (17.4%) with perineal infection and 3 cases (1.1%) with hernia. There were 27 cases occurring tumor recuration. The reason of adverse complications concluded non-popular to perineal anatomy, non-adequate perineal resection, tumor infiltration, non-propal menifestation and inherahhation and mal-catheration.. Conclusions Adequate section designed and familiar to perineal anatomy in order to judge the right edge of infiltrated tumor can decrease adverse complications of APR. The improved suturing technique of pelvic-perineal and effective cathetering can also decrease the adverse complications.更多还原