腹腔镜手术治疗直肠间质瘤16例临床分析  

Laparoscopic surgery for rectal stromal tumor:a report of 16cases

作　　者：应俊[1] 姚骏[1] 张剑[1] 王治国[1] 胡志前[1] 

机构地区：[1]第二军医大学长征医院普外一科,上海200003

出　　处：《第二军医大学学报》2017年第8期1071-1074,共4页Academic Journal of Second Military Medical University

摘　　要：目的探讨腹腔镜下切除直肠间质瘤的可行性及安全性。方法 2013年5月-2016年12月在我科接受行腹腔镜直肠间质瘤切除术的患者共16例,其中男性10例、女性6例,肿瘤直径均小于5cm。肿瘤下缘距肛缘大于5cm者行腹腔镜下直肠前切除术(Dixon术),肿瘤下缘距肛缘小于5cm且大于3cm者行腹腔镜下局部切除术,肿瘤下缘距肛缘小于3cm且与周边组织界限不清者则行腹腔镜下腹会阴联合切除术(Miles术)。结果 16例直肠间质瘤患者均在腹腔镜下成功切除肿瘤,无一例中转开腹手术,无术后穿孔、出血、梗阻、吻合口漏等并发症发生。其中,12例行腹腔镜下直肠前切除术(Dixon术),3例行腹腔镜下局部切除术,1例行腹腔镜下腹会阴联合切除术(Miles术)。平均手术时间(103.0±23.8)min,平均住院时间(7.0±1.2)d,平均术中出血(14.0±4.1)mL。术后病理证实为间质瘤,切缘阴性。随访8~40个月,无一例患者复发。2例患者肿瘤转移至肝脏,并最终死于肝转移。结论腹腔镜下直肠间质瘤切除是安全、可行的,手术创伤小,住院时间短,术后恢复快。Objective To explore the feasibility and safety of laparoscopic resection for rectal stromal tumor.Methods Sixteen（10 male and 6female）patients underwent laparoscopic resection of rectal stromal tumor in our department from May 2013 to Dec.2016,and the tumor diameter of all patients was less than 5cm.The patients with the distance of more than 5cm from the lower margin of the tumor to the anal verge received laparoscopic anterior resection of the rectal carcinoma（Dixon）,the patients with the distance of less than 5cm and more than 3cm received laparoscopic local resection,and the patients with the distance of less than 3cm,whose tumor boundary with the surrounding tissue were unclear,received laparoscopic abdominal perineal resection（Miles）.Results The rectal stromal tumors of 16 cases were successfully removed under laparoscope without conversion to laparotomy,and no post-operative complications such as perforation,bleeding,obstruction or anastomotic leakage occurred.Of 16 cases,12underwent laparoscopic anterior resection of the rectal carcinoma（Dixon）,3 underwent laparoscopic local resection,and 1underwent laparoscopic perineal resection（Miles）.The average operation time was（103.0±23.8）min,the average hospital stay was（7.0±1.2）days,and the average volume of intra-operative bleeding was（14±4.1）mL.The pathological findings were confirmed as stromal tumor with negative margin.There was no recurrence during the followup of 8to 40 months.Two cases with the tumor transferring to the liver eventually died of liver metastasis.Conclusion Laparoscopic resection of rectal stromal tumors is safe and feasible,with less trauma,shorter hospitalization time and quicker post-operative recovery.

关 键 词：直肠肿瘤 间质瘤 腹腔镜检查 微创性外科手术 

分 类 号：R735.37[医药卫生—肿瘤]