腹腔镜全直肠系膜切除保肛术治疗低位直肠癌的临床疗效分析  

Clinical curative effect analysis of laparoscopic total mesorectal excision with sphincter preservation for low rectal cancer

作　　者：刘继东[1] 阎玉矿[1] 李德宁[1] 王宏伟[1] 辛乐[1] 叶进军[1] 鲍兴[1] 

机构地区：[1]深圳市龙岗中心医院普外科,518116

出　　处：《中华腔镜外科杂志（电子版）》2015年第3期46-49,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜全直肠系膜切除（TME）保肛术治疗低位直肠癌的可行性、安全性及疗效。方法回顾性分析深圳市龙岗中心医院2011年1月至2014年1月66例患者行腹腔镜低位直肠癌保肛术的临床资料。结果 65例患者完成腹腔镜TME保肛术,其中3例行回肠预防性造瘘,1例中转行Miles术。手术时间（158.2±12.8）min,手术切除淋巴结14~28枚,肿瘤下缘距远切缘（2.26±0.27）cm。术后恢复排气时间2~5 d。术后总并发症率18.5%（12/65）,其中吻合口瘘5例（7.7%）,4例进行双套管持续冲洗引流保守治疗后治愈,1例二次手术行横结肠造瘘术后痊愈。随访时间12~48个月（平均20个月）,局部吻合口复发2例,均二次行腹会阴联合直肠癌根治术;7例远处转移,其中死亡3例。早期均有不同程度的排便功能障碍,经训练,术后12个月肛门功能的优良率为89.2%。结论腹腔镜TME保肛术治疗低位直肠癌安全、可行,不仅能达到根治要求,而且保肛术效果良好,符合现代外科对低位直肠癌根治和保肛并重的治疗理念。Objective To investigate the feasibility,safety and curative effect of laparoscopic Total Mesorectal Excision with sphincter preservation for low rectal cancer. Methods The clinical data of66 patients with low rectal cancer,who underwent laparoscopic sphincter-preserving surgery,between Jan.2011 and Jan. 2014 in our hospital were retrospectively analyzed. Results Sixty five patients had received laparoscopic TME with sphincter preservation. Preventive ileostomy was performed in 3 cases,and 1 case was transferred to Miles operation. The operation time was（ 158. 2 ± 12. 8） minutes. Fourteen to twenty-eight lymph nodes were harvested. The distance between tumor to the distant margin was（ 2. 26 ± 0. 27） cm. Bowel function recovered 2-5 days after the operation. Twelve（ 18. 5%） patients suffered from postoperative complications including anastomotic fistula in 5 cases（ 7. 7%）,4 of which cases were cured by conservative treatment and 1 received transverse colostomy. During the follow-up period ranged from 12 to 48 months（ Average 20 months）,two patients with anastomotic recurrence received Miles operation,7 patients developed distant metastasis,and 3 patients died. All patients had bowel dysfunction shortly after surgery,but anal function excellent rate was 89. 2% after postoperative 12 months. Conclusions The procedure of laparoscopic TME with sphincter preservation is safe and feasible for low rectal cancer,which can achieve not only radical demands but good anal function.

关 键 词：腹腔镜 低位直肠癌 全直肠系膜切除术 保肛术 

分 类 号：R735.37[医药卫生—肿瘤]