摘要腹会阴联合切除术(APE)和全直肠系膜切除术(TME)明显改善了直肠癌患者的预后.然而,与直肠癌前切除术相比,低位直肠癌的环周切缘(CRM)阳性率和术中穿孔(IOP)的发生率仍然很高.经肛提肌外腹会阴联合切除术(ELAPE)可以降低直肠癌手术的CRM阳性率和肿瘤穿孔率,降低术后局部复发率,从而可能提高患者的生存率.然而,术中操作时间长、创伤大和术后会阴并发症发生率高,使ELAPE备受争议.本文对ELAPE的操作要点、优缺点、研究现状和发展前景等进行综述.

abstractsThe application of extralevator abdominoperineal excision (ELAPE) and total mesotectal excision has improved the prognosis of rectal cancer.However,compared with anterior resection for rectal cancer,the circumferential resection margin (CRM) positive rate and intraoperative perforation (IOP) rate are still high.The ELAPE can reduce the CRM positive rate and IOP rate,therefore reduce postoperative local recurrence rate and increase the survival rate of patients.The disadvantage of its trauma,longer operative time,and higher perineum complication in ELAPE is controversial.This review mainly discusses the key points of operative procedure,advantages and disadvantages,research status and development prospects of ELAPE.