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目的报告柱状经腹会阴直肠癌切除术(cylindrical abdominoperineal resection)和使用人类脱细胞真皮基质(human acellular dermal matrix,HADM)进行盆底重建的初步应用结果。方法北京朝阳医院普外科自2008年1月至2009年1月,采用柱状经腹会阴直肠癌切除术治疗10例低位直肠癌。腹部操作中不将直肠系膜从肛提肌分离。会阴操作中采用俯卧折刀位,在进入盆腔之前环周解剖出肛提肌。切除尾骨和部分骶5,切开Waldeyer筋膜进入盆腔,从后向前切断两侧肛提肌。在会阴横肌的后方切断盆底肌纤维并将直肠和肛管完整切除,标本呈圆柱状。盆底缺损使用人脱细胞真皮基质重建。结果所有病人无直肠穿孔,病理示环周切缘阴性,术后会阴伤口I期愈合。平均随访9个月,无会阴伤口感染、裂开、膨出和疝的发生。发生无症状血清肿1例和会阴疼痛2例。结论柱状经腹会阴直肠癌切除术可以降低Miles手术环周切缘阳性率和肠穿孔率,HADM盆底重建可以降低手术难度。
Objective To report the preliminary results of pelvic floor reconstruction using cylindrical abdominoperineal resection and human acellular dermal matrix (HADM). Methods The Department of General Surgery, Beijing Chaoyang Hospital from January 2008 to January 2009, the columnar abdominal perineal resection for the treatment of 10 cases of low rectal cancer. The mesorectum is not separated from the levator ani in abdomen operation. Perineal operation prone position knife position, before the pelvic dissection into the levator ani muscle. Excision of the coccyx and part of the sacral 5, cut Waldeyer fascia into the pelvis, from behind to cut off both sides of the levator ani muscle. In the perineum transverse posterior muscle fibers cut off the pelvis and the rectum and anal complete resection, cylindrical specimens. Reconstruction of pelvic floor defects using human acellular dermal matrix. Results All patients had no rectal perforation. The pathology showed a negative circumferential margin, and the perineal wound was healed postoperatively. The average follow-up of 9 months, no perineal wound infection, rupture, bulging and hernia occurred. 1 case of asymptomatic seroma and 2 cases of perineal pain. Conclusions Peritoneal peritoneal resection of pelvic peritoneum can reduce the positive margins of margins and bowel perforation rate in Miles operation. HADM pelvic floor reconstruction can reduce the difficulty of operation.