腹腔镜低位直肠癌切除经肛门套入式吻合保肛术首例报告  

Transanal telescopic anastomosis after laparoscopic anterior resection of low rectal cancer:report of case

作　　者：李世拥[1] 陈钢[1] 陈光[1] 袁强[1] 

机构地区：[1]北京军区总医院普通外科,北京100700

出　　处：《中华普外科手术学杂志（电子版）》2011年第2期17-19,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜低位直肠癌切除经肛门套入式吻合保肛术的可行性和安全性。方法腹部手术:按4孔法Trocar,用超声刀剪完成清扫肠系膜根部其周围淋巴结,系膜下动静脉根部结扎切断,直肠游离至尾骨尖肿瘤远端5cm。肛门手术:采用5针悬吊法暴露术野,距齿状线上缘1cm处环型切开,沿黏膜下锐性向上剥离至提肛肌平面,切断直肠,将直肠肿瘤及远端乙状结肠一并从肛门移出体外切除,行套入式近端结肠全层与直肠黏膜及肠黏膜下用可吸收线间断缝合。结果手术时间为160min,腹部手术约为120min,经肛门套入式吻合操作40min,术中失血量约为60ml,术后3d肠蠕动恢复肛门排气,术后第6天进流质饮食,术后第7天拔出腹腔引流管,各Trocar口愈合良好。术后病理:直肠高中分化腺癌,癌组织浸润肠壁深肌层,淋巴结未见转移癌(0/29),T2N0M0;术后未发生并发症。术后腹部手术真正微创、无切口美观,随访4周一切良好。结论腹腔镜低位直肠癌切除经肛门套入式吻合保肛术式安全可行。Objective To report the first case of laparoscopic anterior resection with transanal telescopic anastomosis for low rectal cancer,and to investigate the safety and feasibility of the procedure.Methods Laparoscopically,lymphatic tissue around the mesentery was scavenged using 4 trocars,and the root of the inferior mesenteric vessel was ligated and cut off,while dissociating the rectum 5 cm distal to the tumor margin.Transanally,a loop-like incision was made 1.0 cm above the anocutaneous line using 5-suture suspending for exposure,the submucous layer was striped upward to the layer of the levator ani muscle,and then all the specimens were cut and removed.Finally,colon-anal anastomosis was made by using telescopic technique.Results The total operation time was 160 minutes,including 120 minutes for the laparoscopic procedure,and 40 minutes for the transanal procedure.Intraoperative blood loss was 60 ml.Bowel function recovered on post-operative day 3.The patient was given liquid diet on day 6.On day 7,wound healed,and the abdominal drainage tube was removed.Pathological diagnosis demonstrated high-moderate differentiated rectal adenocarcinoma（T2N0M0） and malignant tissue infiltrated into the deep muscular layer of the rectum,with no lymphatic metastasis（0/29）.Follow-up for 4 weeks revealed no postoperative complication.ConclusionsIt is feasible to make a laparoscopic anterior resection with transanal telescopic anastomosis for low rectal cancer.

关 键 词：直肠肿瘤 腹腔镜检查 结直肠外科手术 保肛术 

分 类 号：R735.37[医药卫生—肿瘤]