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词汇介绍
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解析
abdominoperineal [æb'dɔminə,peri'ni:əl]
释义 adj. 腹会阴的
例句 Among locally advanced rectal/rectosigmoid cases, surgery included abdominoperineal resection or low anterior resection.
局部进展性直肠/直肠乙状结肠病例，手术治疗包括腹会阴联合切除术或低位前切除术。
resection 英 [rɪ'sekʃn] 美 [rɪ'sekʃn]
释义 n. [外科] 切除术
例句 Local residual early cancer after endoscopic resection
内镜切除后局部残留早期癌症
概述
概述
腹会阴联合切除术，又称Miles手术，是治疗低位直肠癌不保肛手术的标准术式。适用于肿瘤位置非常低或括约肌功能差的患者，该手术需完全切除结肠末端与直肠及肛门括约肌复合体，切除范围包括乙状结肠远端、全部直肠、肠系膜下动脉及其区域淋巴结、全直肠系膜、肛提肌、坐骨直肠窝内脂肪、肛管及肛门周围约5cm直径的皮肤、皮下组织及全部肛门括约肌，于左下腹行永久性乙状结肠单腔造口。
适应症
腹膜返折以下的直肠癌，肿瘤下缘距齿线6cm以内的（如肿瘤分化低，局部浸润深，可延长到8cm以内），且无远距离转移者。
禁忌症
若病人梗阻明显，宜行二期手术，预先做结肠造口，待梗阻解除后，再行切除术。
手术方式
（1）括约肌间方式；
（2）外提肌方式；
（3）坐骨肛门窝方式。
术前检查
（1）结肠镜/乙状结肠镜；
（2）病理组织学检查；
（3）计算机断层扫描结肠成像；
（4）磁共振、经直肠内镜超声。
手术过程
（1）准备 给予患者全身麻醉并取截石位；
（2）下腹正中切口，绕脐右侧；
（3）探查腹腔；
（4）分离乙状结肠及其系膜；
（5）结扎肠系膜下动、静脉 将十二指肠横部向上拉开；
（6）分离直肠后侧、前侧，切断直肠侧韧带；
（7）切开腹壁作结肠造瘘口；
（8）切断乙状结肠，提出乙状结肠造瘘肠管；
（9）缝合后腹膜、腹壁切口、结肠造瘘口；
并发症
Miles术常见并发症有出血、感染、副损伤、人工肛门并发症/肠梗阻等。
后遗症
在治疗上认为miles手术是中低位直肠癌治疗的金标准，但缺点明显，有局部直肠癌复发率高；切缘残留肿瘤阳性率高；手术过程中容易发生直肠肿瘤穿孔，导致肿瘤种植复发。切除范围广、功能性损坏大及永久性肠造口等因素，对病人术后的某些正常功能——如排便功能、排尿功能、性功能等影响较大；手术并发症和术后肠造口所出现的问题严重影响病人术后的生活和生存质量。
复制标题垂直腹直肌肌皮瓣修复局部晚期直肠癌腹会阴联合切除术后会阴创面愈合
发表时间：2018-11-20
影响指数：3.7
作者： Milan Spasojevic
期刊：Ann Surg Oncol
Treatment of low locally advanced rectal cancer (LARC) frequently requires abdominoperineal resection (APR), often in combination with multivisceral resections,1 resulting in a large dead space in the pelvic cavity and the risk of non-tension-free closure of the perineal wound. In addition, the majority of the patients receive neoadjuvant (chemo) radiotherapy (C)RT, which, in combination with the above-mentioned factors, predisposes patients to surgical site infection and delayed perineal wound healing.2–4 These complications contribute to prolonged hospital stay and the necessity for repeat wound debridement, adversely affecting the patients’ quality of life and significantly increasing the cost of medical treatment.5 In an attempt to reduce perineal wound morbidity, the vertical rectus abdominis musculocutaneous (VRAM) flap repair has been advocated as a valuable alternative to direct perineal wound closure, with a reported absolute risk reduction of perineal wound complications of up to 17%.6 The rationale behind this is that the placement of nonirradiated, well-vascularized tissue to the perineal wound improves wound healing. However, due to the heterogeneity of present studies7–10 and the absence of sufficiently powered prospective studies,11 the efficacy of VRAM flap in reducing perineal wound morbidity remains uncertain. The aim of this study was to compare perineal wound morbidity after APR for LARC in patients with VRAM flap repair to direct perineal wound closure.
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