腹腔镜全直肠系膜切除术治疗中低位直肠癌(附74例报道)  

Laparoscopic Total Mesorectal Excision in Treatment of Mid-Low Rectal Cancer(Report of 74 Cases)

作　　者：陈伟平[1] 黄新[1] 李其肯[1] 李德川[1] 

机构地区：[1]浙江省肿瘤医院大肠外科,杭州310022

出　　处：《中国普外基础与临床杂志》2009年第10期793-795,共3页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨腹腔镜全直肠系膜切除术（TME）治疗中低位直肠癌的可行性及临床疗效。方法选取2005年3月至2008年7月期间我院行腹腔镜TME的中低位直肠癌患者,收集其临床病理资料进行分析。结果74例中低位直肠癌患者接受腹腔镜TME,无中转开腹手术,无手术死亡病例。手术时间平均为187 min,术中失血量平均为90 ml,术后住院时间平均为10 d,肠道功能恢复时间平均为46 h。远端切缘距肿瘤距离平均为3.1 cm,清除淋巴结数平均为19.7枚。肿瘤下缘距肛缘6 cm以上患者保肛率为97%（29/30）。随访时间2~44个月（平均25个月）,术后并发症发生率为9.5%。无戳孔肿瘤细胞种植或远处转移发生;1例盆腔复发,带瘤生存;无死亡病例。结论腹腔镜TME能够达到和符合TME的原则,治疗中低位直肠癌是可行的。Objective To evaluate the feasibility and clinical outcomes of laparoscopic total mesorectal excision（TME） in treating mid-low rectal cancer.Methods From March 2005 to July 2008,74 patients with mid-low rectal cancer undergoing laparoscopic TME in Zhejiang Cancer Hospital were collected.The data of clinicopathologic parameters were analyzed.Results Laparoscopic TME was performed on 74 patients with mid-low rectal cancer.No operative death occurred in this group.No case was converted to open procedure.The mean operation time was 187 min.The mean operative blood loss was 90 ml.The mean postoperative hospital stay was 10 d.Bowel function was restored on 46 h after operation on average.The mean distance between tumor and the section edge was 3.1 cm.The average number of lymph node dissection was 19.7.The sphincter preservation rate was 97% in patients with tumor 6 cm above the anal verge.The follow-up times were 2-44 months,average 25 months.The incidence of complications was 9.5%.No tumor cell port site implantation or distant metastasis happened.One case was pelvic recurrence,no patient was dead.Conclusion Laparoscopic TME is a feasible,safe and minimally invasive technique for the patients with mid-low rectal cancer,achieving the principles of TME.

关 键 词：腹腔镜 全直肠系膜切除术 直肠肿瘤 并发症 

分 类 号：R735.37[医药卫生—肿瘤]