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腹会阴联合切除术(APE)和全直肠系膜切除(TME)明显改善了直肠癌病人的预后。然而,与直肠癌前切除手术(AR)相比,低位直肠癌的环周切缘(CRM)阳性率和术中穿孔(IOP)的发生率仍然很高,这是导致复局部发率高的重要因素。提肛肌外腹会阴联合切除术(ELAPE)可明显降低CRM阳性率和IOP发生率,增加局部根治性。在欧洲,ELAPE被认为是治疗低位直肠癌的外科新理念。ELAPE手术要求在会阴区沿提肛肌外侧平面操作,腹部手术遵循TME原则。明确解剖标志和操作原则可缩短外科医生的学习曲线。
Abdominal perineal resection (APE) and total mesorectal excision (TME) significantly improve the prognosis of patients with rectal cancer. However, the rate of peri-operative margins (CRM) and intraoperative perforation (IOP) is still high in rectal cancer compared with resection of rectal cancer (AR), which leads to a high rate of relapse Key factor. Levator ani external abdominal perineal resection (ELAPE) can significantly reduce the rate of CRM and IOP incidence of IOP, increased local radical. In Europe, ELAPE is considered a new surgical concept for the treatment of low rectal cancer. ELAPE surgery in the perineal area along the lateral levator ani plane operation, abdomen surgery follow the TME principle. Clear anatomical signs and operating principles can shorten the surgeon’s learning curve.