腹腔镜辅助经肛全直肠系膜切除术治疗直肠癌的长期疗效观察  

Long-term efficacy of laparoscope-assisted transanal total mesorectal excision for rectal cancer

作　　者：张大朝 陈远光[1] 胡明[1] 黄炯强[1] 夏同义[1] 叶志伟[1] 温广明[1] 詹高房 雷建[1] 曾毅克[1] 陈劲松[1] 柯传烽[1] Zhang Dachao;Chen Yuanguang;Hu Ming;Huang Jiongqiang;Xia Tongyi;Ye Zhiwei;Wen Guangming;Zhan Gaofang;Lei Jian;Zeng Yike;Chen Jinsong;Ke Chuanfeng(Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China)

机构地区：[1]广州医科大学第一附属医院胃肠外科,510120

出　　处：《中华胃肠外科杂志》2019年第3期262-266,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省医学科学技术研究基金(c2015050).

摘　　要：目的探讨腹腔镜辅助经肛全直肠系膜切除术(taTME)治疗直肠癌的长期疗效。方法收集2010年5月至2015年12月期间,广州医科大学附属第一医院胃肠外科成功行腹腔镜辅助taTME的29例中低位直肠癌患者的病历资料,进行回顾性病例系列研究。全组男性18例,女性11例,平均年龄58.6岁。手术均由经腹、经肛同时或序贯进行操作。记录和分析病理学和围手期情况,并通过随访观察远期复发、转移和生存情况。采用门诊及电话调查方式进行随访,随访截止时间为2018年12月。应用Kaplan Meier法计算总体生存率和无病生存率,并绘制生存曲线。结果29例患者术中出血量20~200(75.9±9.5)ml;手术时间165~280(223.6±4.1)min。术中清扫淋巴结(22.3±2.0)枚,病理标本长度为(13.1±0.6)cm,肿瘤下缘距远端切缘的距离为(2.9±0.2)cm。26例直肠系膜完整,3例近完整;环周切缘阳性者2例。中位随访时间为56(22~91)个月,局部复发率为10.3%(3/29),远处转移率为20.7%(6/29);3年总体生存率为96.6%,3年无病生存率为83.2%,5年总体生存率为87.6%,5年无病生存率为79.6%。随访过程中均无切口疝、粘连性肠梗阻发生。结论腹腔镜辅助taTME手术治疗直肠癌,患者长期生存状况良好。Objective To investigate the long-term outcome of laparoscope-assisted transanal total mesorectal excision (taTME) for rectal cancer. Methods Clinicopathological data of 29 patients with mid-low rectal cancer undergoing laparoscope-assisted taTME at Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangzhou Medical University from May 2010 to December 2015 were collected for the retrospective case-series study. All the operations were performed with transabdominal and transanal procedure simultaneously or sequentially. Perioperative presentations, pathological examinations, and oncologic outcomes were retrospectively analyzed. Long-term recurrence, metastasis and survival were assessed during follow-up. Outpatient clinic and telephone survey were used for follow-up. The follow-up time ended in December 2018. The overall survival (OS) rate and disease-free survival (DFS) rate were calculated by the Kaplan-Meier method. Results The average intra-operative blood loss was (75.9±9.5) ml (range,20 to 200). The average operating time was (223.6±4.1) minutes (range, 165 to 280). The average number of harvested lymph node was 22.3±2.0. The average length of pathological specimen was (13.1±0.6) cm. The average distal resection margin was (2.9± 0.2) cm. 89.7%(26/29) of specimens was complete and 10.3%(3/29) near complete. Two cases (6.9%) had positive cutting circumferential margin. Median follow-up was 56 (range, 22 to 91) months. Local recurrence rate, distant metastasis rate, 3-year OS rate, 3-year DFS rate, 5-year OS rate, 5-year DFS rate were 10.3%(3/29), 20.7%(6/29), 96.6%, 83.2%, 87.6% and 79.6%, respectively. No incisional hernia or adhesive intestinal obstruction was found. Conclusion Long-term outcomes of mid-low rectal cancer patients undergoing laparoscope-assisted taTME are satisfactory.

关 键 词：直肠肿瘤 经肛全直肠系膜切除术 腹腔镜 

分 类 号：R735.37[医药卫生—肿瘤]