The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical...The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer, the identification by "hooking them on the finger" has been accepted by many surgeons with no doubt; clamping, dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks. But in cadaveric studies, many anatomists could not find LLR described by the textbooks, and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision. The anatomy of LLR has diverse descriptions in literatures. According to our clinical observations, the traditional anatomical structures of LLR do exist; LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum, run between rectal visceral fascia and pelvic parietal fascia above the levator ani, and covered by superior fascia of pelvic diaphragm. They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.展开更多
Background： The introduction of individualized abdominoperineal excision （APE） may minimize operative trauma and reduce the rate of complications. The purpose of this study was to evaluate the safety and efficacy o...Background： The introduction of individualized abdominoperineal excision （APE） may minimize operative trauma and reduce the rate of complications. The purpose of this study was to evaluate the safety and efficacy of individualized APE for low rectal cancer. Methods： Fifty-six patients who underwent individualized APE from June 2011 to June 2015 were evaluated retrospectively in Beijing Chaoyang Hospital, Capital Medical University. The main outcome measures were circumferential resection margin （CRM） involvement, intraoperative perforation, postoperative complications, and local recurrence. Statistical analysis was performed using SPSS version 16.0. Results： Fifty （89%） patients received preoperative chemoradiotherapy： 51 （91%） patients were treated with the sacrococcyx preserved; 27 （48%） patients with the levator ani muscle partially preserved bilaterally; 20 （36%） patients with the levator ani muscle partially preserved unilaterally and the muscle on the opposite side totally preserved; 7 （13%） patients with intact levator ani muscle and part of the ischioanal fat bilaterally dissected; and 2 （4%） patients with part of the ischioanal fat and intact lavator ani muscle dissected unilaterally and the muscle on the opposite side partially preserved. The most common complications included sexual dysfunction （12%）, perineal wound complications （13%）, urinary retention （7%）, and chronic perineal pain （5%）. A positive CRM was demonstrated in 3 （5%） patients, and intraoperative perforations occurred in 2 （4%） patients. On multiple logistic regression analysis, longer operative time （P = 0.032） and more intraoperative blood loss （P = 0.006） were significantly associated with perineal procedure-related complications. The local recurrence was 4% at a median follow-up of 53 months （range： 30–74 months）. Conclusion： With preoperative chemoradiotherapy, individualized APE may be a relatively safe and feasible approach for low rectal cancer with展开更多
Background：When compared with conventional abdominoperineal resection （APR）,extralevator abdominoperineal excision （ELAPE） has been demonstrated to reduce the risk of local recurrence for the treatment of locally...Background：When compared with conventional abdominoperineal resection （APR）,extralevator abdominoperineal excision （ELAPE） has been demonstrated to reduce the risk of local recurrence for the treatment of locally advanced low rectal cancer.Combined with the laparoscopic technique,laparoscopic ELAPE （LELAPE） has the potential to reduce invasion and hasten postoperative recovery.In this study,we aim to investigate the advantages of LELAPE in comparison with conventional APR.Methods：From October 2010 to February 2013,23 patients with low rectal cancer （T3-4N0-2M0） underwent LELAPE;while during the same period,25 patients were treated with conventional APR.The patient characteristics,intraoperative data,postoperative complications,and follow-up results were retrospectively compared and analyzed.Results：The basic patient characteristics were similar;but the total operative time for the LELAPE was longer than that of the conventional APR group （P =0.014）.However,the operative time for the perineal portion was comparable between the two groups （P =0.328）.The LELAPE group had less intraoperative blood loss （P =0.022）,a lower bowel perforation rate （P =0.023）,and a positive circumferential margin （P =0.028）.Moreover,the patients,who received the LELAPE,had a lower postoperative Visual Analog Scale,quicker recovery of bowel function （P =0.001）,and a shorter hospital stay （P =0.047）.However,patients in the LELAPE group suffered more chronic perineal pain （P =0.002）,which may be related to the coccygectomy （P =0.033）.Although the metastasis rate and mortality rate were similar between the two groups,the local recurrence rate of the LELAPE group was statistically improved （P =0.047）.Conclusions：When compared with conventional APR,LELAPE has the potential to reduce the risk of local recurrence,and decreases operative invasion for the treatment of locally advanced low rectal cancer.展开更多
文摘The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer, the identification by "hooking them on the finger" has been accepted by many surgeons with no doubt; clamping, dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks. But in cadaveric studies, many anatomists could not find LLR described by the textbooks, and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision. The anatomy of LLR has diverse descriptions in literatures. According to our clinical observations, the traditional anatomical structures of LLR do exist; LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum, run between rectal visceral fascia and pelvic parietal fascia above the levator ani, and covered by superior fascia of pelvic diaphragm. They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.
基金This study was funded ＂by grants＂ from National High Technology Research and Development Program 863 （No. 2015AA033602）, National Natural Science Foundation of China （No. 81541101）, The Capital Health Research and Development of Special Fund （No. Z 121107001012131, No. 2014-4-2033）, Beijing Chaoyang Hospital 1351 Personnel Training Program （No. CYXZ-2017-09）, and the Basic and Clinical Cooperation Project of Capital Medical University （No. 15JL03）.
文摘Background： The introduction of individualized abdominoperineal excision （APE） may minimize operative trauma and reduce the rate of complications. The purpose of this study was to evaluate the safety and efficacy of individualized APE for low rectal cancer. Methods： Fifty-six patients who underwent individualized APE from June 2011 to June 2015 were evaluated retrospectively in Beijing Chaoyang Hospital, Capital Medical University. The main outcome measures were circumferential resection margin （CRM） involvement, intraoperative perforation, postoperative complications, and local recurrence. Statistical analysis was performed using SPSS version 16.0. Results： Fifty （89%） patients received preoperative chemoradiotherapy： 51 （91%） patients were treated with the sacrococcyx preserved; 27 （48%） patients with the levator ani muscle partially preserved bilaterally; 20 （36%） patients with the levator ani muscle partially preserved unilaterally and the muscle on the opposite side totally preserved; 7 （13%） patients with intact levator ani muscle and part of the ischioanal fat bilaterally dissected; and 2 （4%） patients with part of the ischioanal fat and intact lavator ani muscle dissected unilaterally and the muscle on the opposite side partially preserved. The most common complications included sexual dysfunction （12%）, perineal wound complications （13%）, urinary retention （7%）, and chronic perineal pain （5%）. A positive CRM was demonstrated in 3 （5%） patients, and intraoperative perforations occurred in 2 （4%） patients. On multiple logistic regression analysis, longer operative time （P = 0.032） and more intraoperative blood loss （P = 0.006） were significantly associated with perineal procedure-related complications. The local recurrence was 4% at a median follow-up of 53 months （range： 30–74 months）. Conclusion： With preoperative chemoradiotherapy, individualized APE may be a relatively safe and feasible approach for low rectal cancer with
文摘Background：When compared with conventional abdominoperineal resection （APR）,extralevator abdominoperineal excision （ELAPE） has been demonstrated to reduce the risk of local recurrence for the treatment of locally advanced low rectal cancer.Combined with the laparoscopic technique,laparoscopic ELAPE （LELAPE） has the potential to reduce invasion and hasten postoperative recovery.In this study,we aim to investigate the advantages of LELAPE in comparison with conventional APR.Methods：From October 2010 to February 2013,23 patients with low rectal cancer （T3-4N0-2M0） underwent LELAPE;while during the same period,25 patients were treated with conventional APR.The patient characteristics,intraoperative data,postoperative complications,and follow-up results were retrospectively compared and analyzed.Results：The basic patient characteristics were similar;but the total operative time for the LELAPE was longer than that of the conventional APR group （P =0.014）.However,the operative time for the perineal portion was comparable between the two groups （P =0.328）.The LELAPE group had less intraoperative blood loss （P =0.022）,a lower bowel perforation rate （P =0.023）,and a positive circumferential margin （P =0.028）.Moreover,the patients,who received the LELAPE,had a lower postoperative Visual Analog Scale,quicker recovery of bowel function （P =0.001）,and a shorter hospital stay （P =0.047）.However,patients in the LELAPE group suffered more chronic perineal pain （P =0.002）,which may be related to the coccygectomy （P =0.033）.Although the metastasis rate and mortality rate were similar between the two groups,the local recurrence rate of the LELAPE group was statistically improved （P =0.047）.Conclusions：When compared with conventional APR,LELAPE has the potential to reduce the risk of local recurrence,and decreases operative invasion for the treatment of locally advanced low rectal cancer.
