腹腔镜改良经肛门结肠肛管吻合术切除低位直肠癌保肛手术的临床疗效分析  

Study of modified Parks procedure in laparoscopic anus-preserving surgery for low rectal cancer

作　　者：吴超[1] 汪全新[1] 卢晓明[2] 

机构地区：[1]湖北省红安县人民医院普外二科,438400 [2]华中科技大学同济医学院附属协和医院胃肠外科

出　　处：《临床外科杂志》2016年第6期437-439,共3页Journal of Clinical Surgery

摘　　要：目的 分析腹腔镜改良经肛门结肠肛管吻合术（Parks术）治疗低位直肠癌的临床效果.方法 低位直肠癌患者86例,采用腹腔镜下改良Parks术切除肿瘤,结肠肛管吻合,评估其术后并发症、肛门控便、排尿以及性功能状况.结果 术后出现吻合口漏5例,其中吻合口狭窄3例,全部患者随访24 ～48个月,肝、肺转移7例,吻合口局部均无复发,复发死亡2例;术后6个月60.2％ （50/83）患者对排便情况满意,术后1年73.5％（61/83）患者对排便情况满意;术后2年85.4％（70/82）患者对排便情况满意;术后1个月排尿功能障碍发生率为9.6％（8/83）;男性患者术后1个月勃起功能障碍发生率18.0％ （9/50）,射精功能障碍发生率26.0％ （13/50）;66.7％（22/33）女性患者术后3个月对性生活满意.结论 应用腹腔镜下改良Parks术治疗低位直肠癌安全性高、根治效果好,术后患者可获得较满意的控便、排尿及性功能.Objective To investigate the clinical efficacy of laparoscopic anus-preserving surgery （ modified Parks procedure） for low rectal carcinoma. Methods Eighty-six patients with low rectal canc- er who received the modified laparoscopic Parks operation were selected. The postoperative complications, defecation, urination and sexual functions of these patients were also evaluated. Results All clinical data of these patients were collected after a follow-up period of 24 to 48 months. There were five anastomotic leakage cases ,including three cases of anastomotic stricture. Seven cases had liver or lung metastasis. Two ca- ses died of recurrence whereas no case suffered from local anastomotic recurrence. Moreover,50（60.2% ） cases were satisfied with the defecation function for 6 months after the operation, while 61 （73.5%） and 70 （85.4%） cases were in satisfactory for 12 months and 24 months after the operation respectively. The incidence of voiding dysfunction was 9.6% （8/83） during the first month after operation. Furthermore, the incidence of erectile dysfunction and ejaculatory dysfunction was 18% （9/50） and 26% （13/50） for male patients,respectively. A total of 66.7% （22/33） female patients were satisfied with sex. Conclusion Modified Parks procedure for low rectal cancer is an alternative anus-preserving operation, which can im- prove patient＇s defecation function, sexual and urinary function. The procedure is a safe and effective aher- native operation to improve the postoperative defecation, urination and sexual functions for low rectal canc- er patients.

关 键 词：直肠癌 腹腔镜 结肠肛管吻合术 

分 类 号：R735.37[医药卫生—肿瘤]