目的总结采用腹腔镜下经肛提肌外腹会阴联合切除(ELAPE)治疗低位进展期直肠癌的应用体会。方法回顾性分析徐州医学院附属医院胃肠外科2012年1月至2015年5月期间采用腹腔镜下ELAPE术治疗的46例进展期低位直肠癌患者的临床资料。会阴部操作采用俯卧折刀位,术中根据肿瘤侵犯肛提肌程度,个体化切除肛提肌范围,会阴部切口缝合皮下和皮肤,腹腔镜下缝合盆底腹膜。分析术中、术后和随访的各项指标。结果46例均顺利完成手术,无术中并发症、腹腔镜相关并发症及中转手术。手术时间(175.3±26.5)min,术中出血量(55.7±28.6)m L,获取淋巴结(16.3±7.7)枚。所有标本上的肛提肌均附着在直肠系膜上,肠管断端及侧切缘均阴性。结论腹腔镜下ELAPE术可以切除更多的肿瘤周围组织,降低环周切缘阳性率,减少术中肠穿孔的发生,降低局部复发。同时腹腔镜直视下的操作有暴露良好、解剖精细等优点,个性化切除肛提肌可进一步减少并发症的发生。 Objective To summarize the experience of using laparoscopic extrapebral perineal resection (ELAPE) in the treatment of low-grade advanced rectal cancer. Methods The clinical data of 46 patients with advanced low rectal cancer treated by laparoscopic ELAPE from January 2012 to May 2015 in Department of Gastrointestinal Surgery of Affiliated Hospital of Xuzhou Medical College were retrospectively analyzed. Perineal operation prone position knife position, according to the degree of tumor invasion of levator ani muscle, the scope of individual levator ani muscle resection, perineal incision suture subcutaneous and skin, laparoscopic pelvic peritoneal suture. Analysis of intraoperative, postoperative and follow-up of the indicators. Results All the 46 cases were successfully performed the operation without any intraoperative complications, laparoscopic-related complications and transurethral resection. The operation time (175.3 ± 26.5) min, intraoperative blood loss (55.7 ± 28.6) m L, access to lymph nodes (16.3 ± 7.7) pieces. Levator ani on all specimens were attached to the mesorectum, the intestinal segment and lateral margin were negative. Conclusions Laparoscopic ELAPE can excise more surrounding tissues, reduce the positive rate of circumferential margin, reduce the incidence of intraoperative intestinal perforation and reduce the local recurrence. At the same time, laparoscopic operation under direct vision has good exposure, fine dissection and other advantages, personalized resection of levator ani can further reduce the incidence of complications.