腹部无切口经肛门切除标本的腹腔镜低位直肠癌根治套入式吻合保肛术  

Transanal laparoscopic radical resection with telescopic anastomosis for low rectal cancer

作　　者：李世拥[1] 陈纲[1] 杜峻峰[1] 陈光[1] 魏晓军[1] 崔伟[1] 袁强[1] 孙亮[1] 白雪[1] 左富义[1] 于波[1] 东星[1] 季锡清[1] 

机构地区：[1]北京军区总医院普通外科,100700

出　　处：《中华胃肠外科杂志》2015年第6期581-583,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：探讨腹部无切口经肛门切除标本的腹腔镜低位直肠癌根治套入式吻合保肛术的安全性、可行性及临床疗效。方法总结2010年1月至2014年9月北京军区总医院普通外科对37例肿瘤距肛缘4～7 cm的直肠癌患者施行腹部无切口经肛门切除标本的腹腔镜直肠癌根治套入式吻合保肛术的临床资料。术前评估26例为T1N0M0期，11例为T2N0M0期。结果全组患者均顺利完成手术。手术时间（178±21） min，术中出血量（76±11） ml，检出淋巴结（13±7）枚，术后肛门排气时间为（3．0±1．2） d，均未发生与手术相关并发症，术后（12．0±4．2） d出院。术后12月肛门功能检测结果显示，Kirwan分级1级者占94．6％（35／37），肛门功能基本恢复到正常；术后随访3～45个月，无肿瘤复发。结论腹部无切口经肛门切除标本的腹腔镜低位直肠癌根治套入式吻合保肛术安全可行，临床疗效满意。Objective To assess the safety, feasibility and clinical outcome of laparoscopic radical resection for low rectal cancer with telescopic anastomosis or with colostomy by stapler through transanal resection without abdominal incisions. Methods From January 2010 to September 2014, 37 patients underwent laparoscopic radical resection for low rectal cancer through transanal resection without abdominal incisions. The tumors were 4-7 cm above the anal verge. On preoperative assessment , 26 cases were T1N0M0 and 11 were T2N0M0. Results For all cases, successful surgery was performed. In telescopic anastomosis group, the mean operative time was （178±21） min, with average blood loss of （76±11） ml and （13±7） lymph nodes harvested. Return of bowel function was （3.0±1.2） d and the hospital stay was （12.0±4.2） d without postoperative complications. Patients were followed up for 3-45 months. Twelve months after surgery, 94.6%（35/37） patients achieved anal function Kirwan grade 1, indicating that their anal function returned to normal. Conclusions Laparoscopic radical resection for low rectal cancer with telescopic anastomosis or colostomy by stapler through transanal resection without abdominal incisions is safe and feasible. Satisfactory clinical outcome can be achieved mini-invasively.

关 键 词：直肠肿瘤 低位 腹腔镜 根治手术 腹部无切口 

分 类 号：R735.37[医药卫生—肿瘤]