摘要
目的分析肛提肌外腹会阴联合切除术(ELAPE)后盆底重建方式的优势及缺点,旨在为降低低位直肠癌患者由于ELAPE手术造成的会阴并发症发生率提供参考.方法以"经肛提肌腹会阴联合直肠切除术、腹会阴圆柱切除术、直肠癌、盆底重建、生物网片、肌皮瓣、带蒂大网膜成型"作为中文关键词,"extralevator abdominoperineal excision、ELA-PE、abdominoperineal resection、low rectal cancer、biological mesh、pelvic floor reconstruction、perineal complications、ped-icled omentum plasty"作为英文关键词,在PubMed、EMBASE、Medline、Web of Science、中国知网、中华医学期刊全文数据库等主要医学数据库中搜索2018-01-01-2024-01-31发表的所有研究,没有语言限制.纳入标准:(1)直肠癌流行病学特征;(2)低位直肠癌临床主要治疗方式研究;(3)ELAPE手术指征及手术标准;(4)ELAPE术后会阴并发症的影响因素;(5)盆底组织缺损重建方式研究;(6)ELAPE术后盆底重建方式及对照研究.排除标准:(1)会议和评论类文献;(2)内容相似或重复文献.最终根据纳入及排除标准分析文献56篇(英文文献33篇,中文文献23篇).结果已报道的盆底重建方式有一期封闭、自体或异体组织修复(肌皮瓣修复、带蒂大网膜成型和应用生物网片等).每种方式均有其自身的优势和缺点,目前公认最佳的盆底修复方式尚不明确.相较于其他盆底修复方式,应用生物网片行盆底修复的报道相对较多,生物网片具有操作简单、节省手术时间、降低会阴并发症等优势.越来越多的学者认为组合多种技术能够显著提高盆底修复的成功率和降低术后并发症的发生率,这需要更多的临床样本对照去证实.结论盆底重建方式的选择需要考虑的因素是多方面的,鉴于新辅助治疗对于盆底腹膜及会阴部软组织的影响,低位直肠癌患者需行个体化ELA-PE手术,因此针对术中情况的不同选择合适的盆底重建方式是必要的.
Objective To analyze the advantages and disadvantages of pelvic floor reconstruction after ELAPE in recent years,and to provide guidance and help for related research on reducing the incidence of perineal complications caused by the huge pelvic floor defect caused by ELAPE in patients with low rectal cancer.Methods We searched PubMed,EMBASE,Medline,Science Citation Index,Web of Science,CNKI,Chinese Medical Journal Full-text Database and other major medical databases for all studies published between January 2018and January 2024 without any language restrictions.The following search terms were used as keywords:"levator abdominoperineal resection,abdominoperineal column resection,pelvic floor reconstruction,biological mesh,myocutaneous flap,pedicled omentum plasty,extralevator abdominoperineal excision,ELAPE,abdominoperineal resection,Low rectal cancer,perineal complications.Inclusion criteria:(1)Epidemiological characteristics of rectal cancer;(2)Main clinical treatment modalities for low rectal cancer;(3)Indications and surgical criteria for ELAPE surgery;(4)Influencing factors of perineal complications after ELAPE surgery;(5)Methods of pelvic floor tissue reconstruction;(6)methods and control studies of pelvic floor reconstruction after ELAPE surgery.Exclusion criteria:(1)conference,review;(2)similar or duplicate literature.Finally,55literatures(32in English and 23in Chinese)were analyzed according to inclusion and exclusion criteria.Results The reported methods of pelvic floor reconstruction include primary closure,autologous or allogeneic tissue repair(myocutaneous flap repair,pedicled omentum plasty,biological mesh,etc.).Each method has its own advantages and disadvantages,and the recognized best method for pelvic floor repair is still unclear.In recent years,compared with other pelvic floor repair methods,there are relatively many reports on the application of biological mesh in pelvic floor repair.Biological mesh has the advantages of simple operation,saving operation time and reducing perineal complications.More and more scholars believe that the combination of multiple techniques can significantly improve the success rate of pelvic floor repair and reduce the incidence of postoperative complications,which needs to be confirmed by more clinical samples.Conclusions Many factors should be considered in the selection of the method of pelvic floor reconstruction.In view of the impact of neoadjuvant therapy on pelvic peritoneum and perineal soft tissue,patients with low rectal cancer need to undergo individualized ELAPE surgery.Therefore,it is necessary to choose the appropriate method of pelvic floor reconstruction according to the different intraoperative situations.
作者
朱延袤
孔令琪
孙雷
秦国宁
张焕虎
李幼生
ZHU Yanmao;KONG Lingqi;SUN Lei;QIN Guoning;ZHANG Huanhu;LI Yousheng(Second Clinical College of Binzhou Medical University,Yantai,Shandong265699,China;Clinical College of Weifang Medical University,Weifang,Shandong261053,China;Department of Gastrointestinal Surgery,Weihai Municipal Hospital Affiliated to Shandong University,Weihai,Shandong264200,China;Department of General Surgery,Ninth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200011,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2024年第9期587-592,共6页
Chinese Journal of Cancer Prevention and Treatment
基金
威海市科研项目基金(2015FZA01005)。
