“困难骨盆”男性低位直肠癌患者接受经肛全直肠系膜切除术近期结局——来自北京大学肿瘤医院的单中心报告  

Short-term outcome of transanal total mesorectal excision for male low rectal cancer patients with ＂difficult pelvis＂： a single center report from Peking University Cancer Hospital

作　　者：武爱文[1] 何国礼 王林[1] 董秋石 刘新志 李英杰[1] 冷家骅[1] 张晓[1] 孙婷婷[1] 张悦[1] 姚云峰[1] Wu Aiwen;He Guoli;Wang Lin;Dong Qiushi;Liu Xinzhi;Li Yingjie;Leng Jiahua;Zhang Xiao;Sun Tinging;Zhang Yue;Yao Yunfeng(Ward 3, Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research （Ministry of Education）, Peking University Cancer Hospital and Institute, Beijing 100142, China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所、北京大学肿瘤医院胃肠肿瘤中心三病区恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华胃肠外科杂志》2018年第6期646-653,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81773214）

摘　　要：目的＂困难骨盆＂的低位直肠癌保留肛门括约肌手术无论开放还是腹腔镜下操作均很困难。本研究旨在探讨经肛全直肠系膜切除术（taTME）在＂困难骨盆＂直肠癌患者的应用价值。 方法收集2016年6月至2018年1月间在北京大学肿瘤医院经病理诊断为直肠癌并接受经肛全直肠系膜切除手术的男性患者资料进行回顾性病例系列研究。按照如下标准进行入组病例的筛选：（1）低位直肠癌，肿瘤下缘距肛缘≤ 5 cm；（2）坐骨结节间径〈 5 cm；（3）体质指数（BMI）〉 25 kg/m2；（4）肿瘤横径≤4 cm。分析本组患者taTME手术时间、出血量、术后住院天数、术后并发症及肛门功能情况。 结果本研究共有20例患者符合条件入组，均接受术前新辅助放化疗，BMI中位值27.7（26.2~36.4）kg/m2，坐骨结节间径中位值92.5（78~100）mm，肿瘤下缘距离肛门距离中位值4（2~5）cm。taTME手术分为经腹组和经肛组进行操作，中位手术时间302（215~402）min，中位术中出血量100（50~200）ml，中位术后住院时间9（5~15）d，术后出现并发症5例（25%），其中盆腔感染3例，肠梗阻1例，吻合口漏1例（行乙状结肠造口手术）。无围手术期死亡病例。肛门括约肌保留率100%。19例患者术后1个月接受肛门测压，肛门静息压（41.5 ± 8.6）mmHg，肛门缩榨压（121.0 ± 11.6）mmHg，均在正常范围内。所有患者随访至2018年3月15日，中位随访时间4.5个月，1例出现右侧锁骨上淋巴结转移，全部病例无局部复发。 结论对具困难骨盆因素的男性低位直肠癌患者，行经肛全直肠系膜切除术安全性可以接受，有助于患者肛门括约肌保留。ObjectiveTo explore the applicable value of transanal total mesorectal excision （taTME） in male low rectal cancer patients with narrow pelvis- ＂difficult pelvis＂ , which remains difficult for both open and laparoscopic sphincter-saving operations. MethodsClinical data of male low rectal cancer patients diagnosed by pathology undergoing taTME between June 2016 and January 2018 at Peking University Cancer Hospital were collected. A retrospective cohort study was performed. Patients were selected according to the following criteria： （1） low rectal cancer, the distance between inferior margin of tumor and anal verge ≤ 5 cm; （2） the distance between two sciatic tubercles 〈 5 cm; （3） body mass index （BMI） 〉 25 kg/m2; （4） tumor horizontal diameter ≤ 4 cm. Operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications and anal function were analyzed. ResultsA total of 20 patients were included in this study. All the patients received preoperative neoadjuvant chemoradiation and hybrid transabdominal and transanal surgery. The median BMI was 27.7 （26.2-36.4） kg/m2; the median distance between two sciatic tubercles was 92.5 （78-100） mm; the median distance between the inferior margin of tumor to the anal verge was 4 （2-5） cm; the median operation time was 302 （215-402） min; the median intraoperative blood loss was 100 （50-200） ml; the median postoperative hospital stay was 9 （5-15） d. Postoperative complications occurred in 5 patients （25%） , including 3 pelvic infection, 1 intestinal obstruction, 1 anastomotic leakage receiving sigmoid colostomy. There was no perioperative death. Sphincter-preservation rate was 100%. Nineteen patients received anal manometry 1 month after operation with normal resting pressure （41.5±8.6） mmHg and squeeze pressure （121.0±11.6） mmHg. All the patients were followed up to March 2018, and the median follow-up time was 4.5 months. Only 1 patient had supraclavicular lymph node me

关 键 词：经肛全直肠系膜切除术 困难骨盆 低位直肠癌 肛门括约肌保留 

分 类 号：R735.37[医药卫生—肿瘤]