腹腔镜下低位直肠癌经肛拖出切除吻合术的临床研究  

Clinical study on laparoscopic transanal pull-through resection and anastomosis for low rectal cancer

作　　者：赵文韬[1] 周翔宇[2] 章伟[2] 王自强[2] 

机构地区：[1]广州中医药大学第一附属医院肛肠外科,广东广州510405 [2]四川大学华西医院普通外科,四川成都610041

出　　处：《中国普通外科杂志》2011年第4期352-355,共4页China Journal of General Surgery

摘　　要：目的探讨腹腔镜下低位直肠癌经肛拖出切除吻合术在低位直肠癌治疗中的临床应用价值。方法回顾性分析12例低位直肠癌应用腹腔镜下经肛拖出切除吻合术的临床资料。12例肿瘤锯齿状线为1～3 cm,肿瘤局限在肠腔内,直径均<4 cm,浸润<肠腔1/2,均为高-中分化瘤。均行腹腔镜下全直肠系膜切除,直肠及肿瘤经肛门拖出切除,用吻合器行结直肠或结肛吻合术。结果 12例均顺利完成腹腔镜下手术,无中转开腹手术者。手术时间160～240 min,平均200 min。术中出血30～80 mL,平均40 mL。切缘均无癌残留。胃肠功能恢复时间36～60 h,术后住院时间7～10 d,无吻合口瘘及吻合口出血发生。12例随访12～18个月,未发现局部复发。结论腹腔镜下低位直肠癌经肛拖出切除吻合术准确、简便、安全,为瘤体较小、组织学分型好的早、中期的低位直肠癌提供一种较好的术式选择。Objective To evaluate the value of laparoscopic transanal pull-through resection and anastomosis for treatment of low rectal cancer.Methods The clinical data of 12 patients with low ractal cancer undergoing laparoscopic transanal pull-through resection and anastomosis,were retrospective analysed.Of whom,the tumor located 1-3 cm from the dentate line,less than 4 cm in diameter,invasion of less than 1/2 the circumference of the lumen,localized within the bowel lumen,cell differentiation of high to moderate degree.All of the cases underwent total mesorectal excision（TME） under laparoscopic guidance;the rectum along with the tumor was pulled out from the anus and resected.Finally,the colorectal or coloanal anastomosis was made with stapler.Results Laparoscopic pull-through resection and anastomosis were successfully performed in all 12 cases and without conversions to open surgery.The mean operation time was 200 min（160-240 min）,and the mean intraoperative blood loss was 40 ml（30-80 mL）.In all cases,no residual tumor was found at resection margin.The time for recovery of gastrointestinal function and postoperative hospitalization was 36 to 60 h and 7 to 10 d respectively,and no anastomotic fistula or bleeding was observed.These 12 cases were followed-up for 12 to 18 months,no local relapse was observed.Conclusions Laparoscopic transanal pull-through resection and anastomosis is an effective,simple and safe procedure,and can be as a good operation in treatment of early or middle clinical stage low rectal cancer with favorable histological types and relatively smaller size.

关 键 词：直肠肿瘤/外科学 低位直肠癌 腹腔镜手术 拖出切除吻合术 

分 类 号：R735.3[医药卫生—肿瘤]