腹腔镜辅助经肛全直肠系膜切除术治疗低位直肠癌近期疗效的前瞻性和多中心病例登记研究  

Short term efficacy of laparoscopic assisted transanal total mesorectal excision for low rectal cancer:a prospective,multicenter,case registration study

作　　者：姚宏伟[1] 安勇博 王权[2] 童卫东 武爱文[4] 肖毅[5] 申占龙[6] 张庆彤[7] 冯波[8] 金泽楠 吴鸿伟[1] 张忠涛[1] Yao Hongwei;An Yongbo;Wang Quart;Tong Weidong;Wu Aiwen;Xiao Yi;Shen Zhanlong;Zhang Qingtong;Feng Bo;Jin Zenan;Wu Hongwei;Zhang Zhongtao(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing Key Laboratory of Cancer Invasion and Metastasis Research,Colorectal Neoplasms Clinical Diagnosis and Treatment Research Center,Beijing 100050,China;department of Gastrointestinal Surgery,the First Affiliated Hospital of Jilin University,Changchun 130021,China;"Department of Gastrocolorectal and Anal Surgery,Doping Hospital,Army Medical University,Chongqing 400042,China;department of Gastrointestinal Surgery,Peking University Cancer Hospital,Beijing 100142,China;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;'"Department of Gastrointestinal Surgery,Peking University Peopled Hospital,Beijing 100044,China;Department of Colorectal Surgery,Liaoning Cancer Hospital Institute,Shenyang 110042,China;department of Gastrointestinal Surgery,Ruijin Hospital,Shanghai]iaotong University School of Medicine,Shanghai 200025,China;department of General Surgery,Beijing Pinggu Hospital,Beijing 101200,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科国家消化系统疾病临床医学研究中心,100050 [2]吉林大学第一医院胃肠外科,长春130021 [3]陆军特色医学中心(大坪医院)胃结直肠肛门外科,重庆400042 [4]北京大学肿瘤医院胃肠外科,100142 [5]中国医学科学院北京协和医院基本外科,100730 [6]北京大学人民医院胃肠外科,100044 [7]辽宁省肿瘤医院结直肠外科,沈阳110042 [8]上海交通大学医学院附属瑞金医院胃肠外科,200025 [9]北京市平谷区医院普通外科,101200

出　　处：《中华消化外科杂志》2021年第12期1351-1357,共7页Chinese Journal of Digestive Surgery

基　　金：国家科技支撑计划课题(2015BAI13B09);北京市临床重点专科基金(卓越项目2018-118);北京市医院管理局临床医学发展专项基金(ZYLX201504);首都医科大学附属北京友谊医院科研启动基金(YYQDKT2016-5)。

摘　　要：目的探讨腹腔镜辅助经肛全直肠系膜切除术(taTME)治疗低位直肠癌的近期疗效。方法采用前瞻性研究方法。选取2017年8月至2018年9月国内8家医疗中心收治的80例[吉林大学第一医院27例、陆军特色医学中心(大坪医院)16例、首都医科大学附属北京友谊医院15例、北京大学肿瘤医院10例、中国医学科学院北京协和医院7例、北京大学人民医院2例、辽宁省肿瘤医院2例、上海交通大学医学院附属瑞金医院1例]低位直肠癌行腹腔镜辅助taTME病人的临床病理资料。观察指标:(1)入组病人临床资料。(2)手术情况。(3)术后组织病理学检查情况。(4)术后并发症及住院情况。偏态分布的计量资料以M(范围)表示。计数资料以绝对数和(或)百分比表示。结果 (1)入组病人临床资料:筛选出符合研究条件的病人80例;男59例, 女21例;中位年龄为61岁, 年龄范围为53~79岁。(2)手术情况:80例病人均顺利完成手术, 手术方式为直肠低位前切除术73例、Hartmann手术4例、经括约肌间腹会阴联合切除术1例、其他手术方式1例, 缺失手术方式资料1例。80例病人中, 19例由经肛经腹两组医师同时行手术。80例病人手术时间为255 min(211~305 min);术中出血量≤500 mL 77例、>500 mL 3例;吻合方式为器械吻合44例、手工吻合24例, 缺失吻合方式资料12例;标本取出途径为经肛门取出66例、经Pfannenstiel切口取出2例、经其他途径取出10例, 缺失标本取出途径资料2例;术中行预防性造口术57例、放置肛管32例、游离脾曲30例、中转开腹2例。(3)术后组织病理学检查情况:80例病人中, 标本系膜完整、近似完整、不完整分别为68、5、1例, 缺失标本系膜完整性资料6例;发生直肠穿孔、环周切缘阳性、远端切缘阳性病人各1例。80例病人淋巴结清扫数目、肿瘤长径分别为12枚(9~16枚)、3.0 cm(1.9~4.0 cm)。80例病人中, 4例获得肿瘤病理学完全缓解Objective To investigate the short term efficacy of laparoscopic assisted transanal total mesorectal excision(taTME)for low rectal cancer.Methods The prospective study was conducted.The clinicopathological data of 80 patients who underwent laparoscopic assisted taTME for low rectal cancer in 8 medical centers,including 27 cases in the First Affiliated Hospital of Jilin University,16 cases in the Daping Hospital of Army Medical University,15 cases in the Beijing Friendship Hospital of Capital Medical University,10 cases in the Peking University Cancer Hospital,7 cases in the Peking Union Medical College Hospital of Chinese Academy of Medical Sciences,2 cases in the Peking University People's Hospital,2 cases in the Liaoning Cancer Hospital Institute,1 case in the Ruijin Hospital of Shanghai)iaotong University School of Medicine,from August 2017 to September 2018 were collected.Observation indicators:(1)clinical data of enrolled patients;(2)surgical situations;(3)postoperative histopathological examination;(4)postoperative complications and hospitalization.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers and(or)percentages.Results⑴Clinical data of enrolled patients:a total of 80 patients were selected for eligibility.There were 59 males and 21 females,aged from 53 to 79 years,with a median age of 61 years.(2)Surgical situations:all 80 patients underwent surgery successfully,including 73 cases undergoing low anterior resection,4 cases undergoing Hartmann operation,1 case undergoing intersphincteric and abdominoperineal resection,1 case undergoing other operations and 1 case missing operation information.Nineteen of the 80 patients underwent transabdominal and transanal operations simultaneously.The operation time of 80 patients was 255 minutes(range,211-305 minutes).Of 80 patients,77 cases had the volume of intraoperative blood loss^500 mL,3 cases had the volume of intraoperative blood loss>500 mL,44 cases underwent instrumental anastomosis,24 cas

关 键 词：直肠肿瘤 经肛全直肠系膜切除术 环周切缘 低位直肠癌腹腔镜辅助经肛全直肠系膜切除术-01研究 中国taTME病例登记协作研究数据库 

分 类 号：R735.37[医药卫生—肿瘤]