腹腔镜下直肠癌超低位保肛手术108例报告  

Laparoscopic Sphincter Preserving Surgery for Ultra Low Rectal Cancer: Report of 108 Cases

作　　者：张永康[1] 刘韵[1] 

机构地区：[1]襄阳市中心医院普外科湖北文理学院附属医院,襄阳441021

出　　处：《中国微创外科杂志》2016年第4期294-296,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜手术在低位直肠癌行超低位保肛手术中的价值。方法 2006年4月～2015年1月完成腹腔镜下直肠癌超低位保肛手术108例。腹腔镜下完成直肠系膜切除及淋巴结清扫,Endo-GIA于肿瘤下缘2 cm处离断直肠,扩大右下腹主操作孔切除标本及完成管状吻合器底钉座置入操作,回纳近端结肠后重新建立气腹,29号管状吻合器经肛门在腔镜下完成结-直肠端端吻合。结果 108例手术在腹腔镜下顺利完成,无中转开腹,无手术死亡。手术时间68～145min,平均104 min;术中出血量10～100 ml,平均40 ml;术后肛门恢复排气时间1～3.5 d,平均2.3 d;淋巴结清扫数8～37枚,平均12.5枚。98例术后随访6～62个月,平均24.6月,无穿刺孔种植转移和吻合口复发。结论腹腔镜下全直肠系膜切除超低位保肛手术可行。Objective To explore advantages of laparoscopic sphincter preserving surgery for ultra low rectal cancer.Methods From April 2006 to January 2015,we performed laparoscopic sphincter preserving surgery in 108 cases of ultra-low rectal cancer. After laparoscopic mesorectal resection and lymph node dissection were completed,transection of the rectum was performed with the Endo-GIA at 2 cm from the lower margin of the tumor. The right lower abdomen main operation port was expanded to remove the lesion and introduce the stapler base. The proximal colon was returned and the pneumoperitoneum was re-established. A colorectal end-to-end anastomosis was conducted through the anus by using a carliber 29 circular stapler. Results Laparoscopic operation was successfully accomplished in all the 108 cases. No conversion to open surgery was required. No operative mortality was encountered.The operation time was 68- 145 min（ mean,104 min）,the intraoperative blood loss was 10- 100 ml（ mean,40 ml）,the postoperative flatus time was 1- 3. 5 d（ mean,2. 3 d）,and the number of removed lymph nodes was 8- 37（ mean,12. 5）. There were 98 patients followed up for 6- 62 months（ mean,24. 6 months）. No tumor metastasis or recurrence was found. Conclusion Laparoscopic total mesorectal excision of ultra low sphincter preserving operation is feasible.

关 键 词：腹腔镜手术 保肛 低位直肠 

分 类 号：R735.37[医药卫生—肿瘤]