经肛门全直肠系膜切除治疗低位直肠癌的安全性和可行性  

Feasibility and safety of transanal total mesorectal excision for distal rectal carcinoma

作　　者：杨选华[1] 杨华[1] 任明扬[1] 李权林[1] 黄斌[1] 蒲敏[1] 袁春艳[1] 

机构地区：[1]川北医学院第二临床医学院.南充市中心医院胃肠外科,四川南充637000

出　　处：《西部医学》2017年第7期958-961,965,共5页Medical Journal of West China

基　　金：四川省医学科研课题(S15049);南充市科技局课题(15A0088)

摘　　要：目的探讨经肛门全直肠系膜切除术(TaTME)的安全性和可行性。方法回顾性分析2015年1月~2016年12月在南充市中心医院接受经肛门全直肠系膜切除的22例低位直肠癌患者的临床资料。结果 22例患者均顺利完成手术,无中转开腹患者。其中男性8例,女性14例,年龄(63.7±12.6)岁,体重指数(BMI)为(23.4±2.5)Kg/m2。肿瘤距肛缘的距离(4.9±1.2)cm。手术时间272.5(125~375)min,术中失血量40(10~300)ml。系膜标本大体完整性Nagtegaal法评价:19例(86.4%)完整,3例(13.6%)近完整;环周切缘阳性1例(4.5%),标本远切端距肿瘤下缘1.8(0.5~4)cm,获检淋巴结14(7~37)枚。无术中及术后30d内死亡病例,1例(4.5%)患者术中损伤盆壁致术中出血。全组患者发生术后并发症6例(27.3%),术后住院时间12.2(10~21)d。截至投稿为止,除肝转移而死亡1例外,尚未发现有肿瘤复发和转移。结论初步数据显示,经肛门全直肠系膜切除术治疗低位直肠癌是安全可行的,并且不影响肿瘤学根治性。Objective The aim of the current study was to evaluate the clinical feasibility and safety of transanal total mesorectal excision for distal rectal carcinoma. Methods Clinical data of twenty-two patients （8males and 14females） with low rectal cancer underwent the transanal total mesorectal excision in our department from January 2015 to December 2016 were retrospectively analyzed. Results The surgery was smoothly completed for all the patients in this studying group, with no conversion to open surgery. The mean age was 63.7±12.6 years, the mean body mass in- dex was 23.4±2.5 kg/m^2 ,and the tumor＇s mean distance from the anal verge was 4.9±1.2cm. The median operating time was 272.5 minutes （range, 125-375 minutes）, and the median estimated blood loss was 40mL （range, 10-300 mL）. The macroscopic quality assessment of the resected specimen was complete in 86.4%, nearly complete in 13.6 %, the cir- cumferential resection margin positivity rate was 4. 5%, the median distal margin wasl. 8 cm （0.5-4）, and the median number of harvested lymph nodes was 14（7-37）. Intra-operative morbidity occurred in 4.5% and the post-operative mor- bidity rate was 27.3%. Conclusion TaTME appears to he an oncologically safe and effective technique for distal meso- rectal dissection with pathological outcomes and morbidity profile.

关 键 词：经肛门微创手术 全直肠系膜切除 直肠癌 

分 类 号：R657.1[医药卫生—外科学]