经肛腔镜部分内括约肌切除术治疗超低位直肠癌的应用价值  

Application value of transanal endoscopic partial intersphincteric resection for ultra-low rectal cancer

作　　者：王廷豪 洪清琦[2] 陈东汉[2] 林和新 余荒岛 李永文[2] 陈逸南 黄安乐[2] 尤俊 Wang Tinghao;Hong Qingqi;Chen Donghan;Lin Hexin;Yu Huangdao;Li Yongwen;Chen Yinan;Huang Anle;You Jun(School of Clinical Medicine,Fujian Medical University,Fuzhou 350122,China;Department of Gastro-intestinal Oncology Surgery,the First Affiliated Hospital of Xiamen University,Xiamen 361003,China)

机构地区：[1]福建医科大学临床医学部,福州350122 [2]厦门大学附属第一医院胃肠肿瘤外科,361003

出　　处：《中华消化外科杂志》2021年第10期1098-1104,共7页Chinese Journal of Digestive Surgery

基　　金：白求恩公益基金项目(HZB-20190528-10);福建省自然科学面上项目(2020J011247)。

摘　　要：目的探讨经肛腔镜部分内括约肌切除术(ISR)治疗超低位直肠癌的应用价值。方法采用回顾性描述性研究方法。收集2017年12月至2020年8月厦门大学附属第一医院收治的9例超低位直肠癌行经肛腔镜部分ISR病人的临床病理资料;男8例,女1例;中位年龄为58岁,年龄范围为39~62岁。观察指标:(1)手术及术后情况。(2)术后病理学检查情况。(3)随访情况。采用门诊和电话方式进行随访,了解病人术后肿瘤局部复发与远处转移,生存,造瘘口还纳,还纳后3个月肛门功能,直肠癌术后6个月男性病人性功能、排尿功能,女性病人性功能情况。随访时间截至2021年2月。正态分布的计量资料以x±s表示。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果(1)手术及术后情况:9例病人均顺利完成手术,无中转开腹。9例病人中,7例行经肛腔镜部分ISR,2例由于肿瘤下缘位于齿状线水平,行经肛腔镜改良部分ISR。9例病人手术时间为(267±48)min,术中出血量为50 mL(30~60 mL)。9例病人中,5例经肛移除标本,4例经腹移除标本。9例病人均采用经肛手工吻合完成消化道重建,均行保护性回肠造口术,术后均留置2根盆腔引流管。9例病人中,3例留置肛管,6例未留置肛管;3例发生术中不良事件,6例未发生术中不良事件。9例病人术后首次肠造口排气时间为3 d(2~4 d),术后首次进食半流质食物时间为5 d(4~7 d),术后30 d发生Clavien-Dindo分级Ⅰ级并发症1例、Ⅱ级并发症2例,余6例病人均未见术后相关并发症;9例病人均无吻合口出血、狭窄及尿潴留。9例病人术后住院时间为11 d(9~23 d),住院总费用为(6.8±1.3)万元。(2)术后病理学检查情况:9例病人肿瘤长径为(3.2±1.4)cm,远端切缘距离为0.6 cm(0.5~1.5 cm),淋巴结清扫数目为(17±7)枚,阳性淋巴结数目为0枚(0~7枚),肿瘤病理学类型均为腺癌,肿瘤结节与神经浸润均为阴性,仅1例病人发�Objective To investigate the application value of transanal endoscopic partial intersphincteric resection for ultra-low rectal cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 9 ultra-low rectal cancer patients undergoing transanal endoscopic partial intersphincteric resection at the First Affiliated Hospital of Xiamen University from December 2017 to August 2020 were collected.There were 8 males and 1 female,aged from 39 to 62 years,with a median age of 58 years.Observation indicators:(1)surgical and postoperative situations;(2)postoperative pathological examination;(3)follow-up.Follow-up was conducted using outpatient examination and telephone interview to detect postoperative tumor local recurrence and distant metastasis,survival of patients,ileostomy closure,anus function at 3 months after ileostomy closure,male urinary and sexual function and female sexual function at 6 months after rectal surgery.The follow-up was up to February 2021.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results(1)Surgical and postoperative situations:all 9 patients underwent surgery successfully,without conversion to open surgery.Seven of the 9 patients underwent transanal endoscopic partial intersphincteric resection and the rest of 2 patients with tumor close to the dentate line underwent transanal endoscopic modified partial intersphincteric resection.The operation time and volume of intraoperative blood loss of 9 patients were(267±48)minutes and 50 mL(range,30‒60 mL),respectively.Five of the 9 patients underwent transanal specimen extraction,and 4 patients underwent specimen extraction by an abdominal incision.All 9 patients underwent transanal hand-sewn coloanal anastomosis and protective ileostomy,and two pelvic drainage tubes were indwelled.Transanal drainage tube was placed after anastomosis in 3 of 9 patients.Three cases had

关 键 词：直肠肿瘤 保肛手术 部分内括约肌切除术 经肛腔镜手术 近期疗效 排便功能 泌尿生殖功能 

分 类 号：R735.37[医药卫生—肿瘤]