腹腔镜直肠癌根治经肛门切除标本套入式吻合术的临床疗效  

Clinical efficacy of laparoscopic radical resection for rectal cancer using transanal telescopic anastomosis

作　　者：李世拥[1] 陈纲[1] 杜峻峰[1] 崔伟[1] 陈光[1] 于波[1] 季锡清[1] 袁强[1] 

机构地区：[1]北京军区总医院普通外科,100700

出　　处：《中华消化外科杂志》2015年第11期930-934,共5页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（30471700、81041025）

摘　　要：目的探讨腹腔镜直肠癌根治经肛门切除标本套入式吻合术的临床疗效。方法回顾性分析2010年3月至2014年12月北京军区总医院收治的52例低位直肠癌患者的临床资料。患者行腹腔镜直肠癌根治经肛门切除标本套入式吻合术。术后对T2N1期以上患者行常规化疗。疗效评价指标包括：手术时间、术中出血量、淋巴结检出数目、术后肛门排气时间、盆腔引流管拔除时间、术后住院时间、术后并发症、切缘情况、术后肛门排便功能、肿瘤局部复发情况。采用门诊、住院和电话方式进行随访，随访内容包括并发症发生情况、术后肛门排便功能及肿瘤局部复发情况，随访时间截至2015年3月。正态分布的计量资料以面±s表示，偏态分布的计量资料以M（范围）表示。结果52例患者均成功行经肛门切除标本的套入式吻合保肛腹腔镜低位直肠癌根治术；手术时间为（150±36）min，术中出血量为（16±9）mL，淋巴结检出数目为（12±9）枚，术后肛门排气时间为（2．0±1．5）d，盆腔引流管拔除时间为（5．0±2．0）d，术后住院时间为（9．0±2．5）d。术后发生吻合口瘘1例，予横结肠造口，3个月后还纳愈合良好。术后病理学检查结果：高中分化腺癌46例，低分化腺癌6例；TNM分期：T1—2NOM0期29例，T2N1～2M0期23例；肿瘤下切缘和环周切缘均为阴性。52例患者术后早期进食后排便次数为6～9次／d，予复方苯乙哌啶片2片／次口服，3次／d，服药后2—3d排便次数可控制在3～6次／d。术后23例T2N1期以上患者行常规化疗。52例患者术后均获得随访，中位随访时间为29．7个月（3．0—51．0个月）。术后2—3个月排便自控能力明显改善。术后12个月肛门排便功能Kirwan1级占94．2％（49／52），肛门排便功能基本恢复正常。其余3例患者均为Kirwan2级。随访期间，1例患者发生吻合口狭窄，经扩�Objective To investigate the clinical efficacy of laparoscopic radical resection for rectal canc- er using transanal telescopic anastomosis. Methods The clinical data of 52 patients with low rectal cancer who underwent laparoscopic radical resection using transanal telescopic anastomosis at the General Hospital of Beijing Military Command from March 2010 to December 2014 were retrospectively analyzed. Patients with T2N1 stage received the routine chemotherapy after operation. The evaluating indexes of clinical efficacy included operation time, volume of intraoperative blood loss, number of lymph nodes dissection, time to anal exsufflation, pelvic drainage-tube removal time, duration of hospital stay, postoperative complications, marginal states, postoperative anal defecation function and local recurrence of tumors examinations and telephone interview up to March 2015, Patients were followed up by outpatient and inpatient and follow-up included the occurrence of complications, postoperative anai defecation function and local recurrence of tumors. Measurement data with normal distribution were presented as x ＋ s, and measurement data with skew distribution were described as M （range）. Results Fifth-two patients underwent transanal laparoscopic sphincter-preserving radical resection using telescopic anasto- mosis successfully. The operation time, volume of intraoperative blood loss, number of lymph nodes dissection, time to anal exsufflation, pelvic drainage-tube removal time and duration of hospital stay were （ 150 ± 36） minutes,（ 16 ± 9） mL, 12 ±9, （2.0 ± 1.5 ） days, （5.0 ± 2.0） days and （9.0±2.5 ） days, respectively. One patient with anastomotic fistula was cured by transverse eolostomy, with a stoma healing 3 months later. The postoperative pathological examination showed there were 46 patients with high- and moderate- differentiated adenocarcinomas and 6 patients with poor-differentiated adenocarcinomas, and T1-2NOMO stage was detected in 29 patients and T2N1-2M0 stage in 23 pat

关 键 词：直肠肿瘤 根治术 套入式吻合术 腹腔镜检查 

分 类 号：R735.37[医药卫生—肿瘤]