腹腔镜低位直肠癌括约肌切除术的思考与展望

结直肠癌（CRC）是世界上常见的消化道恶性肿瘤，发病率在男性患者中居第 3 位、女性患者中居第 2 位，严重危害着人类健康。在中国，尤以低位直肠癌为主，约占直肠癌的 60%~75%。对于低位直肠癌常规选择腹会阴联合切除术（abdomino perineal resection，APR），但是患者需要承担永久性造口的痛苦。对胃肠外科医师来说，如何在肿瘤根治效果与保留肛门功能之间达到最佳平衡是目前研究的重点。腹腔镜 ISR 手术逐渐成为能为大多数患者提供肿瘤根治和保肛兼顾的手术模式。笔者通过查阅文献从 ISR 手术背景、手术适应症及术前评估、手术分型、手术微创化趋势及 ISR 术后肛门功能等五个方面展开综述。

The role of perineal application of prophylactic negative-pressure wound therapy for prevention of wound-related complications after abdomino-perineal resection: a systematic review

Background Closed perineal wounds often fail to heal by primary intention after abdomino-perineal resection (APR) and are often complicated by surgical site infection (SSI) and/or wound dehiscence. Recent evidence showed encouraging results of prophylactic negative-pressure wound therapy (pNPWT) for prevention of wound-related complications in surgery. Our objective was to gather and discuss the early existing literature regarding the use of pNPWT to prevent wound-related complications on perineal wounds after APR. Methods Medline, Embase, and Web of Science were searched for original publications and congress abstracts reporting the use of pNPWT after APR on closed perineal wounds. Results Seven publications were included for analysis. Two publications reported significantly lower incidence of SSI in pNPWT patients than in controls with a risk reduction of about 25–30%. Two other publications described similar incidences of SSI between the two groups of patients but described SSI in pNPWT patients to be less severe. One study reported significantly lower incidence of wound dehiscence in pNPWT patients than in controls. Conclusion The largest non-randomized studies investigating the effect of pNPWT on the prevention of wound-related complications after APR showed encouraging results in terms of reduction of SSI and wound dehiscence that deserve further investigation and confirmation.

Abdominal perineal resection surgery: case report

Colorectal cancer in known to be the most diagnosed cancer in the world, the set gold standard for the treatment of colorectal cancer is excision of the tumor via surgery. There is different type of surgeries that tend to be performed depending on the location, size and extent of the mass in order to avoid recurrence. The main aim of this paper is to discuss the abdominal perineal resection surgery together with the complications faced and criteria in managing these complications intraoperatively.