探讨3D腹腔镜经腹会阴联合切除术（APR）的科学流程及相关体会。

回顾性分析长治医学院附属和平医院2016年1月至2018年10月成功行3D腹腔镜APR手术的90例低位直肠癌患者资料。对APR手术流程进行改良：会阴部手术开始于游离直肠后间隙；会阴部与腹部相通时至完整游离切除标本的时间段，与在开始做造口切口时至完成腹膜外造口第Ⅱ步的时间段一致；重建盆底腹膜其后1/3部分+腹膜外造口第Ⅲ步与会阴部的缝合将同步进行完成。

无中转开腹手术，术中出血量为（120.4±41.6）ml，手术时间（165.7±30.5）min。术后首次排气时间为2（1~6） d，住院时间为（14.5±2.3）d；发生切口感染3例，肠粘连和造口旁疝各1例，尿潴留5例，造口水肿1例。90例行3D腹腔镜APR手术患者全部治愈，随访8（6~14）个月，无局部复发和远处转移。

掌握3D腹腔镜APR手术的科学流程，使得腹部与会阴部协调统一，有助于缩短手术时间，增加手术安全性。

To explore the scientific process and related experience of 3D laparoscopic abdominoperineal resection (APR) surgery.

A retrospective analysis was carried out of ninety patients who successfully underwent 3D laparoscopic APR from January 2016 to October 2018 in the Peace Hospital Affiliated to Changzhi Medical College. The procedure of APR was improved: (1) Perineal surgery started by freeing the posterior rectal space. (2) The period from the time when the perineum communicated with the abdomen to the complete free excision of the specimen was the same the time period as stoma incision to the completion of the step of the extraperitoneal stoma. (3) Rebuild the posterior 1/3 of the pelvic peritoneum + extraperitoneal stoma step and the suture of the perineum completed simultaneously.

There was no conversion to open surgery. The intraoperative blood loss was (120.4±41.6) ml and the operation time was (165.7±30.5) min. The first exhaust time was 2 days (1-6 days), and the hospital stay was (14.5±2.3) days. Postoperative infection occurred in three cases, intestinal adhesion in one case, para stomal hernia in one case, urinary retention in five cases, stoma slobber in one case. All the patients were cured by 3D laparoscopic APR surgery. No local recurrence or distant metastasis was found during the follow-up period of 8 (6-14) months.

It is helpful to shorten the operation time, and increase the safety to master the scientific process of 3D laparoscopic APR operation, which makes the abdomen and perineum coordinate and unify.