腹腔镜下免保护性造口经肛拖出式一期结肠肛管吻合术在低位直肠癌保肛术中的应用价值  

Laparoscopic transanal one-stage pull-through coloanal anastomosis with no protective stoma in the anal preservation treatment of low rectal cancer

作　　者：梁鸿 姚富强 杨成城 郑伟 张辉 白军伟 李俊蒙 张超 Hong Liang;Fuqiang Yao;Chengcheng Yang;Wei Zheng;Hui Zhang;Junwei Bai;Junmeng Li;Chao Zhang(Department of Gastrointestinal Surgery,He'nan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450006,China;The First Clinical College of Hainan Medical University,Haikou 571199,China)

机构地区：[1]河南省人民医院、郑州大学人民医院胃肠外科,450006 [2]海南医科大学第一临床学院,海口571199

出　　处：《中华结直肠疾病电子杂志》2025年第1期91-96,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：河南省卫生计生科技英才海外研修工程项目(No.HWYX2019116)。

摘　　要：目的探讨腹腔镜下免保护性造口经肛拖出式一期结肠肛管吻合术(LOPC)在低位直肠癌保肛治疗中的应用价值。方法采用描述性研究方法,回顾性分析2020年2月至2023年3月河南省人民医院收治的21例T1~T2期低位直肠癌行LOPC治疗患者的临床病理资料,其中,男性11例,女性10例,中位年龄56(40~69)岁,观察患者术中及术后手术相关指标、并发症、肛门功能和肿瘤复发情况。随访截止到2023年9月1日。结果21例患者均顺利完成LOPC,均保留肛门,无中转开腹或手术方式变更。全组中位手术时间200(115~280)分钟,中位出血量100(50~300)mL,均未行预防性造口,所有患者均可进行R0切除,中位清扫淋巴结数量为17(12~26)个,术后中位平均住院时间为10(7~13)天,无术后吻合口漏,无围手术期死亡者。患者均获得术后随访,中位随访12(6~41)个月,术后6个月中位LARS评分26(19~40)分,随访期间无肿瘤复发转移。结论腹腔镜下免保护性造口经肛拖出式一期结肠肛管吻合术治疗低位直肠癌是安全可行的。Objective To investigate the application value of laparoscopic transanal one-stage pull-through coloanal anastomosis with no protective stoma(LOPC)in the anal preservation treatment of low rectal cancer.Methods A retrospective descriptive research was conducted.Retrospective analysis of the clinical and pathological data of 21 patients with T1~T2 stage low rectal cancer treated with LOPC at He'nan Provincial People's Hospital from February 2020 to March 2023.There were 11 males and 10 females,with a median age of 56(40~69)years.The patient's intraoperative and postoperative surgical indicators,complications,anal function,and tumor recurrence were all recorded.The deadline for follow-up is September 1,2023.Results All 21 patients successfully completed LOPC and retained their anus,without any conversion to open surgery or changes in surgical methods.The median surgical time was 200(115~280)minutes,with a median bleeding volume of 100(50~200)milliliters.No protective stoma was performed,and all patients were eligible for R0 resection.An average of 17(12~26)lymph nodes were cleared,and the average hospital stay was 10(7~13)days.There were no postoperative anastomotic leakage or perioperative deaths.All patients received postoperative follow-up,with a median follow-up of 12(6~41)months and a LARS score of 26(19~40)points at 6 months postoperatively.There was no tumor recurrence or metastasis during the follow-up period.Conclusion LOPC is safe and effective for the treatment of low rectal cancer.

关 键 词：直肠肿瘤 腹腔镜 前切除术 结肠肛管吻合 

分 类 号：R735.3[医药卫生—肿瘤] R73[医药卫生—临床医学]