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目的:探讨近年来国内外柱状腹会阴联合切除术(cylindrical APR,CAPR)治疗低位直肠癌的研究进展。方法:应用PubMed及CNKI期刊全文数据库检索系统,以“直肠肿瘤和腹会阴联合切除术”等为关键词,检索2007-03-2014-01相关文献。纳入标准:1)CAPR的理论依据;2)CAPR的技术要点;3)CAPR的手术效果;4)CAPR的实践和探索。根据纳入标准符合分析的文献32篇。结果:CAPR可降低低位直肠癌患者的环周切缘阳性率和术中穿孔率及肿瘤术后并发症和复发率;CAPR是在遵循TME的腹腔操作和会阴部操作同时进行下而完成,腹部和会阴部分别采取平卧位和折刀位;CAPR应用盆底重建降低手术并发症,腹腔镜等微创手术应用于CAPR取得进展;CAPR应用MR检查获益,达到个体化治疗效果。结论:CAPR提高了低位直肠癌的总体疗效,但仍需要大样本的随机对照研究来进一步证实,其疗效也有赖于外科医生经验的逐渐积累。
Objective: To investigate the research progress of cylindrical APR (CAPR) in the treatment of low rectal cancer at home and abroad in recent years. Methods: Using PubMed and CNKI journals full text database retrieval system, with the keywords of “rectal tumor and abdominal perineum resection” as the key word, the related articles of 2007-03-2014-01 were retrieved. Inclusion criteria: 1) the theoretical basis of CAPR; 2) the technical points of CAPR; 3) the surgical effect of CAPR; 4) the practice and exploration of CAPR. According to the inclusion criteria, 32 articles were analyzed. Results: CAPR could reduce the positive rate of peri-circumferential margins and the perforation rate and the postoperative complication and recurrence rate of patients with low rectal cancer. CAPR was performed under the simultaneous peritoneal and perineal operations following TME. And perineal were taken supine and folding position; CAPR pelvic floor reconstruction to reduce complications, laparoscopic minimally invasive surgery and other minimally invasive surgery in the progress of CAPR; CAPR application of MR examination benefit, to individualized treatment. CONCLUSIONS: CAPR improves the overall efficacy of low rectal cancer, but a larger randomized controlled trial is still needed to confirm that its efficacy depends on the surgeon’s experience.