Objective To summarize the clinical procedures and advantages of the hvperthermal tumor-free cylindrical abdominoperi-neal resection(CAPR) for low rectal cancer. Methods The treatment methods,complications and clinical efficacy of 75 patients with low rectal cancer,who underwent the perineum cylindrical resection according to total mesorectal excision(TME) principles from June 2007 to January 2009 in this hospital,were retrospectively analyzed. Results All the patients were treated by pelvic TME combined with cAPR in a lithotomy position. During and after the operation, no rupture of the tumor and split of surgical wounds occurred. The pathological results showed the circumferential resection margins were not invaded by tumor tissues in 69 cases (92.0% ). Perineal incision was infected in 3 cases(4.0% ). A total of 68 patients(90.7% ) were followed up for 36 -48 months. Of 68 patients,3 had local recurrence(4.0% ) ,4 had liver metastasis(5.2% ) ,but no incision hernia occurred. Conclusion The cylindrical abdominoperineal resection is the principle for the advanced low rectal cancer operations without saving the anus, and is also a technical innovation in decreasing the postoperative local recurrence of low rectal cancer.%目的 总结低位直肠癌高热无瘤柱状腹会阴切除术(cylindrical abdominoperineal resection,CAPR)的临床操作方法和治疗优势. 方法 对我院2007 -06 ～2009 -01盆腔遵从TME原则、会阴部柱状切除的75例低位直肠癌患者的根治性切除术方法、并发症及疗效等临床资料进行回顾性总结分析. 结果 手术全程采取膀胱截石体位,盆腔TME联合会阴部扩大柱状切除,无肠破裂穿孔,69例病理示环周切缘阴性(92.0％),3例会阴伤口感染(4.0％).全组68例获随访(90.7％),随访时间36 -48个月,3例局部癌复发(4.0％),4例患者术后肝脏转移(5.2％),无会阴刀口疝发生. 结论 柱状腹会阴切除是低位进展期直肠癌不保肛手术操作应遵循的原则,高热无瘤切除理念的引入是降低术后局部癌复发的重要技术变革.
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