腹腔镜联合经肛拖出式吻合在低位直肠癌保肛手术中的应用  

The Application of Inosculation by Anus Combined Celoscope in Low Rectal Cancer

作　　者：蔡泽云 唐斌[1] 赵利辉[1] 康安定[2] 江勃年[2] 周波[1] 孙维华[1] 

机构地区：[1]湖南省怀化市第二人民医院暨怀化市肿瘤医院普外科,湖南怀化418000 [2]湖南省肿瘤医院肠道外科,湖南长沙410006

出　　处：《医学信息》2013年第5期245-246,共2页Journal of Medical Information

摘　　要：目的探索腹腔镜全直肠系膜切除术（Total mesorectal excision，AME）联合经肛拖出式吻合保肛术治疗低位直肠癌的可行性及疗效。方法对2007年6月～2012年6月为33例低位直肠癌患者施行腹腔镜全直肠系膜切除术（AME）配合经肛拖出式吻合保肛手术进行回顾性分析。病例选择：肿瘤下缘距齿状线2．0～5．0cm。肿瘤大小10-40cm，病理组织学分级为中—南分化腺癌的患者。腹部：在腹腔镜下TME法分离直肠及其系膜至肿瘤下缘以远2～3cm处。肛门部：在距癌肿下缘2～3cm处直肠后壁横形切开肠管后半周，将肿瘤所在的直肠拖至肛门外，切开近侧肠管后半周．然后边缝边切，直至最后切断肠管远、近端完成吻合。结果33例均顺利完成手术，手术时间150～240min，平均200min；术中出血30～150m1．平均100ml：手术切缘均阴性。术后随访5～36个月，平均18个月，术后发生吻合口瘘4例（12．1％）；肛门坠胀感、排便次数增多16例（48．5％）：术后早期肛门粪污3例（9．1％）；吻合口复发5例（15.2％），肝转移3例（9．1％）。结论腹腔镜下全直肠系膜切除术（AME）联合经肛拖出式吻合保肛术治疗低位直肠癌是可行的，能体现保肛、根治、微创的优点。Objective Explore the feasibility and effect of celoscope total mesorectal excision combined inosculation by anus in low retal cancer. Methods 33 patients of rectal cancer suffered celoscop total mesoreetal excision and inoseulation by anus have been analyzed and reviewed from june 2007 to june 2011 . Case selection： 2.0～5.0cm from cancer below edge to dentate line. Tumor size： 1.0～4.0cm. Pathology grade： middle to high differentiation adenoeareinoma. Surgery method： Rectum has been separated to 2～3 cm from the tumor below edge and exeided back haft circle. Rectum of cancer has been hauled to outer and excided the back half circle of top colon. Excided ends have been sewed up. Another half circle have been excided and sewed up by same method. Results 33 cases have been accomplished. Operation time： 150～240min,average time： 200 min; Operation bleeding capacity： 30～150ml, average bleeding capacity： 100 ml; Edges of cut have not seen cancer cell. Observed time after operation： 5～36 months,average time 18 months; Intestinal fistula after operation： 4 cases （12.1%）;Anus unwell and diarrhea： 16 cases （48.5%）;Forepart anus contamination after operation： 3 cases （9.1% ） ; Local recurrence： 5 cases （ 15.2%; Liver shift： 3 cases （9.1% ）. Conclusion It is feasible for celoscop total mesorectal excision and inoseulation by anus. It have the advantage of minimally invasive and radical and preserving anus operation.

关 键 词：直肠肿瘤 腹腔镜 全直肠系膜切除 保肛手术 

分 类 号：R735.37[医药卫生—肿瘤]