gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2017-0-4-34-39gnck-331Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESЭКСТРАЛЕВАТОРНАЯ БРЮШНО-ПРОМЕЖНОСТНАЯ ЭКСТИРПАЦИЯ ПРЯМОЙ КИШКИ: НЕПОСРЕДСТВЕННЫЕ РЕЗУЛЬТАТЫ В СРАВНЕНИИ С ТРАДИЦИОННОЙ ТЕХНИКОЙEXTRALEVATOR ABDOMINOPERINEAL EXCISION OF THE RECTUM: SHORT-TERM OUTCOMES IN COMPARISON WITH CONVENTIONAL SURGERYМурашкоР. А.MurashkoR. A.noemail@neicon.ruУваровИван БорисовичUvarovI. B.kkod@kkod.ru. uvarovivan@yandex.ruЕрмаковЕ. А.ErmakovE. A.noemail@neicon.ruКаушанскийВ. Б.KaushanskiyV. B.noemail@neicon.ruКоньковР. В.KonkovR. V.noemail@neicon.ruСичинаваД. Д.SichinavaD. D.noemail@neicon.ruСадиковБ. Н.SadikovB. N.noemail@neicon.ruГБУЗ «Клинический онкологический диспансер № 1» Министерства здравоохранения Краснодарского краяРоссияRegional Oncological Center of KrasnodarRussian Federation201730122017043439Copyright © Мурашко Р.А., Уваров И.Б., Ермаков Е.А., Каушанский В.Б., Коньков Р.В., Сичинава Д.Д., Садиков Б.Н., 20172017Мурашко Р.А., Уваров И.Б., Ермаков Е.А., Каушанский В.Б., Коньков Р.В., Сичинава Д.Д., Садиков Б.Н.Murashko R.A., Uvarov I.B., Ermakov E.A., Kaushanskiy V.B., Konkov R.V., Sichinava D.D., Sadikov B.N.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/331

ЦЕЛЬ. Оценить непосредственные результаты экстралеваторной брюшно-промежностной экстирпации (ЭЛБПЭ) прямой кишки (ПК) с лапароскопическим (ЛС) и «открытым» абдоминальным этапом в сравнении с традиционной. МАТЕРИАЛЫ И МЕТОДЫ. Проведен анализ хирургического лечения 90 пациентов, которым выполнена БПЭ в период 2013-2015 гг.: I группа - ЭЛБПЭ (n=42); подгруппа Iа (n=18) - ЛС абдоминальный этап, Iб (n=24) - лапаротомия; II группа - традиционная БПЭ (n=48). РЕЗУЛЬТАТЫ. Длительность операции в I группе составила 250,2± 73,8 мин, при 155,9± 28,4 мин во II (р<0,001). Кровопотеря в Ia подгруппе был статистически значимо ниже, чем в I6 и II группах (193,4 ± 97,6 мл против 307,1 ± 58,4 и 322,3 ± 175,4 мл). Количество послеоперационных осложнений в I группе было меньше чем во II: 3 (7,1 %) против 11 (22,9%) (р=0,03). Послеоперационный период в подгруппе Ia отличался менее выраженными болевыми ощущениями в сравнении с I6, и более ранней активизацией. Частота непреднамеренной перфорации в группе I ниже, чем в группе II (2,4 и 16,7 %, соответственно, р=0,024). Обнаружили достоверно меньшее количество случаев R+ резекции в группе ЭЛБПЭ по сравнению с группой традиционной БПЭ (4,8 % против 22,9 %, р=0,015). ЗАКЛЮЧЕНИЕ. ЭЛБПЭ характеризовалась большей продолжительностью операции, меньшей частотой развития инфекционных осложнений со стороны промежностной раны, меньшей частотой непреднамеренной перфорации кишки и меньшей частотой случаев позитивной циркулярной границы резекции.

AIM. To сотраге short-term outcomes of extralevator abdominoperineal excision (ELAPE) of the rectum with laparoscopic and open abdominаl approach and a conventional abdominoperineal excision (APE). METHODS. А total of 90 patents who underwent APE for low rectal cancer were screened between 2013 and 2015. Patients of the first group (group I, n=42) underwent ELAPE: subgroup 1а (n=18) -with laparoscopic abdominаl approach, 1b (n=24) - llaparotomy; patients of the second group (group 2,n=48) - conventional APE. RESULTS. The operation time for the group 1 was 250,2± 73,8 min vs 155,9 ± 28,4 min for the group 2 (p<0,001). There were significant differences betweensubgroup 1a and subgroup 1b and group 2 in terms of blood loss (193,4± 97,6 ml vs 307,1 ± 58,4 and 322,3 ± 175,4 ml). The postoperative complications rate was lower in the group 1 compared with the group 2 (7,1 % vs 22,9 %, p=0.03).Compared with APE with open abdominаl approach (subgroup Ib and group II), laparoscopic ELAPE patients demonstrated less need in postoperative analgesia and shorter postoperative recovery period.. The rates of inadvertent intra operative bowel perforation in the group I was significantly lower than it was in the group II (2,4 vs 16,7%, p=0,024).The circumferential resection margin involvement rate was lower in the ELAPE group compared with the conventional APE group (4,8 % vs 22,9 %, p=0,015). CONCLUSION: The ELAPE for rectal cancer patients is safe, and is associated with lower postoperative complications rate, circumferential resection margin involvement rate, and intraoperative bowel perforation rate compared with the conventional APE group. Laparoscopic ELAPE has advantages in operative blood loss, duration postoperative analgesia and postoperative recovery over ELAPE and conventional APE with open abdominаl approach.

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