gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctologygnck-1643Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCASE REPORTЛапароскопическая экстралеваторная брюшно-промежностная экстирпации прямой кишки с пластикой тазового дна ягодичной мышцейThe first experience of laparoscopic extralevator abdominoperineal resection of the rectum with perineal reconstruction with gluteal flapИгнатовИван СергеевичIgnatovIvan S.polikarpova-e@yandex.ru1ФГБОУ ВО «Рязанский государственный медицинский университет им. акад. И.П. Павлова» Минздрава России (ул. Высоковольтная, д.9, г.Рязань, 390026, Россия) 2ГБУ РО «Областная клиническая больница» (ул. Интернациональная, д.3а, г.Рязань, 390039, Россия)Россия1Ryazan State Medical University (Visokovoltnaya str., 9, Ryazan, 390026, Russia) 2Ryazan State Clinical Hospital (International str., 3A, Ryazan, 390039, Russia)Russian Federation2021030920212037783Copyright © Игнатов И.С., 20212021Игнатов И.С.Ignatov I.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1643ЦЕЛЬ

ЦЕЛЬ: продемонстрировать первый опыт экстралеваторной брюшно-промежностной экстирпации прямой кишки (ЭлБПЭ ПК) с глютеопластикой.

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ: Пациент К., 71 год поступил с диагнозом рак нижнеампулярного отдела прямой кишки сТ3аN0M1а CRM- EMVI+ (IV st) после неоадъювантной химиолучевой терапии для оперативного лечения. Выполнена лапароскопическая экстралеваторная брюшно-промежностная экстирпация прямой кишки с пластикой дефекта тазового дна лоскутом большой ягодичной мышцы.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: впервые выполнена пластика дефекта тазового дна ягодичной мышцей.

Пациент был активизирован на 2-е сутки, дренажи были удалены на 5-е сутки. На 7-е сутки вскрыта серома промежностной раны без признаков нагноения. Дискомфорта и двигательных нарушений при вставании и ходьбе не отмечено. Пациент выписан в удовлетворительном состоянии на 17-е сутки.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ: представленный клинический случай позволяет считать глютеопластику перспективным методом замещения дефекта тазового дна после ЭлБПЭ ПК.

AIM

AIM: to demonstrate the first experience of extralevator abdominoperineal resection of rectum (ELAPR) with gluteoplasty.

PATIENTS AND METHODS

PATIENTS AND METHODS: Patient K., 71 years old, with a low rectal cancer cT3aN0M1a CRM- EMVI + (IV st) after neoadjuvant chemoradiation therapy was underwent surgical treatment. Laparoscopic extralevator abdominoperineal resection of rectum with gluteoplasty of the pelvic floor was performed.

RESULTS

RESULTS: The first ELAPR with gluteoplasty was performed. The patient was activated on the 2nd day, the drain tubes were removed on the 5th day. On the 7th day, the seroma of the perineal wound was drained without signs of suppuration. No discomfort or movement disorders were noted. The patient was discharged in satisfactory condition on the 17th day.

CONCLUSION

CONCLUSION: the presented clinical case allows us to consider gluteoplasty as a promising method for reconstruction of the pelvic floor defect after ELAPR.

рак прямой кишкиэкстралеваторная брюшно-промежностная экстирпацияглютеопластикаrectal cancerextralevator abdominoperineal resection of the rectumgluteoplastyReferencesКаприн А.Д., Старинский В.В., Шахзадова А.О. Злокачественные новообразования в России в 2019 году (заболеваемость и смертность). М.: МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИЦ радиологии» Минздрава России. 2020; c.4.Kaprin A.D., Starinskij V.V., Shahzadova A.O. Malignant neoplasms in Russia in 2019 (morbidity and mortality). Мoscow: P. Hertsen Moscow Oncology Research Institute - branch of National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation. 2020; p.4 (in Russ).Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA: a cancer journal for clinicians. 1971; 21(6):361–364. DOI: 10.3322/canjclin.21.6.361Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA: a cancer journal for clinicians. 1971; 21(6):361–364. DOI: 10.3322/canjclin.21.6.361Holm T, Ljung A, Häggmark T et al. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. The British journal of surgery. 2007; 94(2):232-238. DOI: 10.1002/bjs.5489Holm T, Ljung A, Häggmark T et al. Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. The British journal of surgery. 2007; 94(2):232-238. DOI: 10.1002/bjs.5489Hawkins AT, Albutt K, Wise PE et al. Abdominoperineal Resection for Rectal Cancer in the Twenty-First Century: Indications, Techniques, and Outcomes. Journal of Gastrointestinal Surgery. 2018; 22(8):1477-1487. DOI: 10.1007/s11605-018-3750-9Hawkins AT, Albutt K, Wise PE et al. Abdominoperineal Resection for Rectal Cancer in the Twenty-First Century: Indications, Techniques, and Outcomes. Journal of Gastrointestinal Surgery. 2018; 22(8):1477-1487. DOI: 10.1007/s11605-018-3750-9West NP, Anderin C, Smith KJ et al. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. The British journal of surgery. 2010; 97(4):588-599. DOI: 10.1002/bjs.6916West NP, Anderin C, Smith KJ et al. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. The British journal of surgery. 2010; 97(4):588-599. DOI: 10.1002/bjs.6916De Nardi P, Summo V, Vignali A et al. Standard versus extralevator abdominoperineal low rectal cancer excision outcomes: a systematic review and meta-analysis. Annals of surgical oncology. 2015; 22(9):2997-3006. DOI: 10.1245/s10434-015-4368-8De Nardi P, Summo V, Vignali A et al. Standard versus extralevator abdominoperineal low rectal cancer excision outcomes: a systematic review and meta-analysis. Annals of surgical oncology. 2015; 22(9):2997-3006. DOI: 10.1245/s10434-015-4368-8Huang A, Zhao H, Ling T et al. Oncological superiority of extralevator abdominoperineal resection over conventional abdominoperineal resection: a meta-analysis. International journal of colorectal disease. 2014; 29(3):321-327. DOI: 10.1007/s00384-013-1794-6.Huang A, Zhao H, Ling T et al. Oncological superiority of extralevator abdominoperineal resection over conventional abdominoperineal resection: a meta-analysis. International journal of colorectal disease. 2014; 29(3):321-327. DOI: 10.1007/s00384-013-1794-6.Negoi I, Hostiuc S, Paun S et al. Extralevator vs conventional abdominoperineal resection for rectal cancer-A systematic review and meta-analysis. American journal of surgery. 2016; 212(3):511-526. DOI: 10.1016/j.amjsurg.2016.02.022.Negoi I, Hostiuc S, Paun S et al. Extralevator vs conventional abdominoperineal resection for rectal cancer-A systematic review and meta-analysis. American journal of surgery. 2016; 212(3):511-526. DOI: 10.1016/j.amjsurg.2016.02.022.Sancho-Muriel J, Ocaña J, Cholewa H et al. Biological mesh reconstruction versus primary closure for preventing perineal morbidity after extralevator abdominoperineal excision: a multicentre retrospective study. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland. 2020; 22(11):714-1723. DOI:10.1111/codi.15225.Sancho-Muriel J, Ocaña J, Cholewa H et al. Biological mesh reconstruction versus primary closure for preventing perineal morbidity after extralevator abdominoperineal excision: a multicentre retrospective study. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland. 2020; 22(11):714-1723. DOI:10.1111/codi.15225.Foster JD, Pathak S, Smart NJ et al. Reconstruction of the perineum following extralevator abdominoperineal excision for carcinoma of the lower rectum: a systematic review. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland. 2012; 14(9):1052-1059. DOI:10.1111/j.1463-1318.2012.03169.x.Foster JD, Pathak S, Smart NJ et al. Reconstruction of the perineum following extralevator abdominoperineal excision for carcinoma of the lower rectum: a systematic review. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland. 2012; 14(9):1052-1059. DOI:10.1111/j.1463-1318.2012.03169.x.Christensen HK, Nerstrøm P, Tei T et al. Perineal repair after extralevator abdominoperineal excision for low rectal cancer. Diseases of the colon and rectum. 2011; 54(6):711-717. DOI: 10.1007/DCR.0b013e3182163c89Christensen HK, Nerstrøm P, Tei T et al. Perineal repair after extralevator abdominoperineal excision for low rectal cancer. Diseases of the colon and rectum. 2011; 54(6):711-717. DOI: 10.1007/DCR.0b013e3182163c89Доманский Н.А., Семиглазов В.В., Карачун А.М. и соавт. Результаты использования миопластики для закрытия дефекта тазового дна после экстралеваторной брюшно-промежностной экстирпации прямой кишки. Сибирский онкологический журнал. 2018; 17(6):35-40. DOI: 10.21294/1814-4861-2018-17-6-35-40Domansky N.A., Semiglazov V.V., Karachun A.M. et al. The results of use of myoplasty for closure of the pelvic floor defect after extralevator abdominoperineal excision of the rectum. Siberian Journal of Oncology. 2018; 17(6):35-40. DOI: 10.21294/1814-4861-2018-17-6-35-40

The authors declare that there are no conflicts of interest present.