折刀位直视下经肛括约肌间切除术在超低位直肠癌保肛中的应用价值  

Application value of transanal intersphincteric resection under direct vision in the Jackknife position in the anal preserving surgery for ultra-low rectal cancer

作　　者：邓俊晖[1] 陈志玉 赵斌[1] 钟国斌 李圳锋 周雄[1] 黄海 黄学军[1] Deng Junhui;Chen Zhiyu;Zhao Bin;Zhong Guobin;Li Zhenfeng;Zhou Xiong;Huang Hai;Huang Xuejun(Department of Colorectal and Anal Surgery,Huizhou Municipal Central Hospital,Huizhou 516001,China)

机构地区：[1]惠州市中心人民医院肛肠外科,惠州516001

出　　处：《中华消化外科杂志》2024年第8期1093-1098,共6页Chinese Journal of Digestive Surgery

摘　　要：目的探讨折刀位直视下经肛括约肌间切除术(ISR)在超低位直肠癌保肛中的应用价值.方法采用回顾性描述性研究方法.收集2021年9月至2022年11月惠州市中心人民医院收治的15例行折刀位直视下经肛ISR联合腹腔镜全直肠系膜切除术治疗超低位直肠癌患者的临床病理资料;男9例,女6例;年龄为(63±9)岁.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.15例患者均顺利完成手术,无中转开腹,其中部分ISR5例、次全ISR 10例,手术时间为(260±30)min,术中出血量为20(10~30)mL,吻合口距肛缘距离为(1.6±0.8)cm,术后住院时间为10(8~13)d,15例患者均采用吻合器完成结肠肛门吻合行预防性回肠末端造口.3例患者术后30 d内发生并发症,其中A级吻合口漏1例,保守治疗后痊愈;吻合口膜性狭窄2例,经扩肛治愈.(2)术后病理学检查情况.15例患者淋巴结清扫数目为(18±6)枚,肿瘤距远切缘距离为1.3(1.0~2.0)cm,切除直肠系膜均完整,近切缘、远切缘及环周切缘均为阴性.15例患者术后肿瘤病理学分期为pT1N0M0期1例、pT2N0M0期9例、pT2N1M0期1例、ypT0N0M0期1例、ypT2N0M0期2例、ypT3N 1M0期1例;组织学分期为中分化腺癌11例,高分化腺癌4例.(3)随访情况.15例患者均获得随访,随访时间为15(12~24)个月,未发生肿瘤局部复发与远处转移,无肿瘤相关死亡.15例患者均行造口回纳术,肛门排便控制能力无障碍5例、轻度障碍8例、重度障碍2例.结论折刀位直视下经肛ISR应用于超低位直肠癌保肛手术安全、可行.Objective To investigate the application value of transanal intersphincteric resec-tion under direct vision in the Jackknife position in the anal preserving surgery for ultra-low rectal cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 15 patients with ultra-low rectal cancer who underwent transanal intersphincteric resection under direct vision in the Jackknife position,combined with laparoscopic total mesorectal excision in Huizhou Municipal Central Hospital from September 2021 to November 2022 were collected.There were 9 males and 6 females,aged(63±9)years.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 outcomes.All the 15 patients underwent operations successfully,without conversion to open abdominal operation.There were 5 cases of partial ISR and 10 cases of subtotal ISR.The operation time and volume of intraoperative blood loss of 15 patients were(260±30)minutes and 20(range,10-30)mL,respectively.The distance from anastomosis to anal margin was(1.6±0.8)cm.The duration of postoperative hospital stay was 10(range,8-13)days,and all 15 patients underwent colonic and anastomosis with staplers and protective ileostomy at the terminal ileum.Three patients had postoperative complications within 30 days after surgery,of whom 1 case with grade A anastomotic leakage was cured after conservative treatment and 2 cases with anastomotic membranous stenosis were cured by anal enlargement.(2)Postoperative pathological examination.The number of lymph nodes dissected of 15 patients was 18±6,and the distance between the tumor and distal resection margin was 1.3(range,1.0-2.0)cm.The surgical specimens of all 15 patients showed complete mesorectum and negative for proximal,distal and circumferential margins.Results of postoperative pathological examination showed that there was 1 case in stage pT1

关 键 词：直肠肿瘤 超低位 经括约肌间切除术 全直肠系膜切除术 折刀位 保肛 

分 类 号：R735.37[医药卫生—肿瘤]