腹腔镜全直肠系膜切除和结肠吻合术治疗直肠癌  

Laparoscopic Total Mesorectal Excision and Colon Anastomosis for Rectal Cancer

作　　者：黄贵和 易应松 鲍刚 陆咏江 Huang Guihe;Yi Yingsong;Bao Gang;Lu Yongjiang(Department of Surgery,China Guihang Group No.2 Hospital,Anshun,561000)

机构地区：[1]中国贵航集团302医院外科

出　　处：《基因组学与应用生物学》2019年第12期5788-5794,共7页Genomics and Applied Biology

摘　　要：腹腔镜结肠吻合术经肛门标本提取并不需要剖腹手术,对于低位直肠癌患者是一种有效的新型手术方式。但是目前经肛门标本提取引起的肿瘤溢出和大便失禁的风险尚不清楚。因此,本研究对直肠癌腹腔镜结肠吻合术经肛门与经腹标本提取的肿瘤和功能结果进行比较,探讨肛门直肠标本提取对患者的影响。2012年至2017年期间,本院有220例低位直肠癌患者接受腹腔镜直肠切除缝合吻合术。122例患者的直肠标本经肛门提取,98例患者经腹腔提取。研究圆周切除边缘、直肠系膜内分级、局部复发、生存期和功能结果。死亡率为0.45%,手术并发症发生率为17.27%。阳性切除边缘率为9.09%,直肠系膜完全切除79.09%,亚完全切除11.81%,不完全切除9.09%。随访51个月后,局部复发率为4.55%,5年总生存率和无病生存率分别为83.18%和70.00%。评分为6 (范围0~20)。经肛门与经腹提取组的死亡率、发病率、周缘切除边缘、直肠系膜分级、局部复发率(4.10%vs 5.10%, p=0.98)、无疾病存活率(71.82%vs 68.18%, p=0.63)无差异,得分也相似(6 vs 6, p=0.92)。经肛门直肠标本提取不影响腹腔镜手术治疗低位直肠癌后的肿瘤学和功能结果,并且有可能达到保护腹壁的效果。Laparoscopic colon anastomosis does not require laparotomy for transanal specimen extraction and is an effective new surgical technique for patients with low rectal cancer. However, the risk of tumor overflow and fecal incontinence caused by extraction of anal specimens is not yet clear. Therefore, this study compared the tumors and functional outcomes of rectal cancer undergoing laparoscopic colon anastomosis transanal and transabdominal specimens, and explored the effect of anorectal specimen extraction on patients. From 2012 to 2017, there were 220 cases of low rectum. Patients with cancer undergo laparoscopic rectal resection and anastomosis. Rectal specimens were taken from the anus in 122 patients and 98 in the abdominal cavity. The circumferential resection margin, intramembrane grading, local recurrence, survival, and functional outcomes were studied. The mortality rate was 0.45%, and the incidence of surgical complications was 17.27%. The margin of positive resection was 9.09%, complete removal of mesorectum was 79.09%, subtotal resection was 11.81%, and incomplete resection was 9.09%. After a follow-up of 51 months, the local recurrence rate was 4.55%, and the5-year overall and disease-free survival rates were 83.18% and 70.00%, respectively. The score is 6(range 0~20).Mortality, incidence rate, peri-marginal resection margin, mesorectal grade, local recurrence rate(4.10% vs 5.10%,p=0.98), disease free survival rate(71.82% vs 68.18%,p=0.63), no difference, similar scores(6 vs 6,p=0.92). The transanal rectal specimen extraction does not affect the oncological and functional outcomes of laparoscopic surgery for low rectal cancer, and may have the effect of protecting the abdominal wall.

关 键 词：结肠吻合术 腹腔镜 低位直肠癌 保留括约肌 经肛门标本提取 

分 类 号：R735.37[医药卫生—肿瘤]