经肛门内镜联合腹腔镜治疗结直肠肿瘤

Total laparoscopic sigmoid and rectal surgery combined with transanal endoscopic microsurgery

目的探讨经肛门内镜联合腹腔镜治疗直肠和乙状结肠肿瘤的可行性及近期疗效。方法回顾性分析2010年5月至2011年5月间在上海交通大学医学院附属瑞金医院接受经肛门内镜联合腹腔镜手术治疗的26例直肠和乙状结肠肿瘤患者的临床资料。结果26例患者均在腹腔镜下成功完成手术，无中转开腹，均未行保护性末端回肠造口。手术时间为（151．6±25．9）min，术中失血量为（200．2±114．7）ml，术后排气时间为（2．0±0．5）d。肿瘤大小为（3．0±0．7）cm，所有手术切缘均阴性，淋巴结检出数为（12．9±2．2）枚。术后有6例患者出现吻合口瘘，均为低位直肠肿瘤患者，其中5例出现于前15例患者中，后11例患者仅1例出现吻合口瘘。全组无输尿管损伤、术后肠梗阻及肺部感染病例。结论经肛门内镜联合腹腔镜技术治疗结直肠肿瘤是一种安全、有效的微创手术方式．是将腹腔镜技术与经自然腔道手术概念相结合的一种进步。

Objective To investigate the feasibility and short-term outcomes of total laparoscopie sigmoid and rectal surgery combined with transanal endoscopic microsurgery （TEM）. Methods The clinical data of 26 patients with co]orectal carcinoma treated by total laparoscopic surgery with TEM between May 2010 and May 2011 in the Shanghai Ruijin Hospital were retrospectively analyzed. Results All the 26 operations were successfully accomplished laparoscopically. There was no conversion to open procedure. No diverting ileostomy was made. The mean operative time was （151.6±25.9） rain. The mean blood loss was （200.2±114.7） ml. The mean time to first flatus was （2.0±0.5） d. The mean tumor size was （3.0±0.7） cm and all resection margins were negative. The mean number of lymph nodes harvested was （12.9 ±2.2）. Six patients developed postoperative anastomotic leakage, all of who had tumors in the lower rectum. There were no ureteral injury, intestinal obstruction, or pulmonary infection. Conclusions Total laparoscopic sigmoid and rectal surgery combined with TEM is a safe and feasible minimally invasive surgery. It is an improvement by combining laparoscopic skills with the concept of natural orifice transluminal endoscopic surgery.