探讨腹腔镜肛提肌外腹会阴联合切除术（L-ELAPE）治疗低位直肠癌的疗效。

回顾性分析中国人民解放军联勤保障部队第九六○医院自2018年5月至2023年5月收治的低位直肠癌109例患者的临床资料，其中行L-ELAPE患者69例作为研究组，行传统腹腔镜腹会阴联合切除术（APE）患者40例作为对照组，对比分析两组患者手术前一般资料、术中观察指标、术后恢复情况、术后长期并发症、泌尿生殖系统评分。

109例患者全部顺利完成手术，研究组和对照组患者的性别、年龄、肿物距肛缘的距离、身体质量指数（BMI）、临床分期及是否应用新辅助治疗等基本情况、术中淋巴结清扫情况、术后恢复排气时间、会阴切口延迟愈合、排尿功能障碍、小肠梗阻、重症肺部感染、术后TNM病理分期、住院时间及性功能障碍差异均无统计学意义（均P>0.05）。两组间患者术中出血量[（136.86±52.53 mL vs. 215.40±70.21 mL），t=6.648，P=0.001]、术中穿孔数[4.34%（3/69）vs. 22.50（9/40），χ²=8.516，P=0.004]、手术时间（178.36±55.32 min vs. 142.47±36.53 min，t=3.663，P=0.001）、环周切缘（CRM）阳性率[2.9%（2/69）vs. 15%（6/40），χ²=5.453，P=0.020]、会阴长期慢性疼痛[18.8%（13/69）vs. 2.9%（2/40），χ²=4.087，P=0.043]、切除尾骨者慢性疼痛[28.6%（10/35）vs. 8.8%（3/34），χ²=4.398，P=0.036]、局部复发率[4.3%（3/69）vs. 15%（6/40），χ²=3.793，P=0.050]差异存在统计学意义。

L-ELAPE手术治疗进展期低位直肠癌，可以降低CRM阳性率、术中肠穿孔及术后局部复发率，术后出现会阴区慢性疼痛可能和术中切除尾骨有关，应用生物补片进行盆底重建安全可行。因此L-ELAPE手术是安全、有效的，值得进一步推广应用。

To investigate the clinical application of laparoscopic extralevator abdominoperineal excision(L-ELAPE) for the treatment of low rectal cancer.

The clinical data of 109 patients with low rectal cancer admitted to the 960th Hospital of the Joint Logistic Support Force of the People’s Liberation Army of China from May 2018 to May 2023 were retrospectively analyzed. Among them, sixty-nine patients who underwent L-ELAPE were assigned to the study group, and 40 patients who underwent traditional laparoscopic abdominoperineal excision(APE) were assigned to the control group. The general data before surgery, intraoperative observation indicators, postoperative recovery, long-term postoperative complications, and urogenital system scores of the two groups were compared and analyzed.

All 109 patients successfully completed their surgeries. The basic conditions of the patients in the study group and the control group, such as gender, age, distance from the tumor to the anal margin, body mass index(BMI), clinical stage, whether neoadjuvant therapy was applied, intraoperative lymph node dissection, postoperative recovery exhaust time, delayed healing of perineal incision, urinary dysfunction, severe pulmonary infection, postoperative TNM pathological stage, hospital stay and sexual dysfunction, showed no statistically significant difference (all P>0.05). The intraoperative blood loss[(136.86±52.53 mL vs. 215.40±70.21 mL), t=6.648, P=0.001]and the number of intraoperative perforations[4.34%(3/69) vs. 22.5(9/40), χ²=8.516, P=0.004], operation time(178.36±55.32 min vs. 142.47±36.53 min, t=3.663, P=0.001), positive rate of circumferential margin(CRM)[2.9%(2/69) vs. 15%(6/40), χ²=5.453, P=0.020], perineum long-term chronic pain[18.8%(13/69) vs. 2.9%(2/40), χ²=4.087, P=0.043)], chronic pain after caudal resection[28.6%(10/35) vs. 8.8%(3/34), χ²=4.398, P=0.036], local recurrence rate[4.3%(3/69) vs. 15%(6/40), χ²=3.793, P=0.050] differences exist statistical significance.

L-ELAPE surgery for advanced low rectal cancer can reduce the positive rate of CRM, intraoperative intestinal perforation and postoperative local recurrence rate. The occurrence of chronic perineal pain after surgery may be related to the resection of the coccyx during the operation. The application of biological patches for pelvic floor reconstruction is safe and feasible.Therefore, the L-ELAPE surgery is safe and effective and deserves further promotion and application.