腹腔镜经肛门结肠肛管吻合在超低位直肠癌保肛手术中的应用  

Application of transanal colo-anal anastomosis in laparoscopic sphincter-preserving operation for ultra-low rectal cancer

作　　者：杨世斌[1] 邓量[1] 李明哲[1] 黎文峰[1] 韩方海[2] 肖隆斌[1] 

机构地区：[1]中山大学附属第一医院东院普通外科,广州510700 [2]中山大学附属第二医院胃肠外科,广州510120

出　　处：《中华普通外科学文献（电子版）》2016年第2期116-119,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：国家卫生计生委医药卫生科技发展项目(W2014RQ06);黄埔区科技计划项目(201544-04)

摘　　要：目的探讨腹腔镜下超低位直肠癌根治术并经肛门结肠肛管吻合术（腹腔镜改良Parks手术）的临床应用。方法回顾性分析2008年12月至2013年4月期间28例腹腔镜改良Parks手术患者（腹腔镜组）和56例开腹手术者（开腹组）的临床资料,探讨其术后并发症以及肛门植物神经功能状况。结果所有患者随访6~52个月,腹腔镜组术后出现吻合口瘘2例（7.1%）,全部行二次横结肠造口手术,出现1例吻合口狭窄,2例排尿困难。开腹组术后出现吻合口瘘5例（8.9%）,2例行二次横结肠造口手术,3例经局部引流通畅,静脉肠外营养支持后瘘口闭合,其他4例并发症主要为性功能和排尿困难。腹腔镜组术后3个月内4例（14.3%）患者出现排便功能障碍,而随着时间的增加,排粪功能优的患者比例并未下降（χ^2=0.778,P=0.678）。结论腹腔镜改良Parks手术可以有效提高超低位直肠癌患者的的保肛率,手术并发症并未增高,术后有较满意的控粪、排尿功能。Objective To explore the clinical application of transanal colo-anal anastomosis in laparoscopic anterior resection for ultra- low rectal cancer（laparoscopic modified Parks operation）.Methods The clinical data of twenty eight cases with laparoscopic modified Parks operation and fifty-six cases with open surgery from December 2008 to April 2013 were retrospectively analyzed. The postoperative complications and anal vegetative nerve function were then discussed. Results Patients were followed up for 6- 52 months. In the laparoscopy group, 2 cases（7.1%） experienced anastomotic leakage, who underwent a transverse colostomy. The anastomotic stricture appeared in 1 case, and dysuresia appeared in 2 cases. In the open surgery group, the anastomotic leakage appeared in 5 cases（8.9%）, of whom 2 cases underwent a transverse colostomy and conservative management was implemented in the other 3 cases. Sexual dysfunction and dysuresia appeared in 4 cases. Four cases in the laparoscopic group appeared to have dysporia within 3 months and the patients with good anal continence remained constant as time went by（χ~2=0.778, P=0.678）. Conclusion The laparoscopic modified Parks operation can effectively improve the sphincter- preserving rate for ultra- low rectal cancer with satisfactory anal continence and urinary function without increasing complications.

关 键 词：直肠肿瘤 腹腔镜 结肠肛管吻合 超低位 

分 类 号：R735.37[医药卫生—肿瘤]