单孔腹腔镜腹会阴联合直肠癌根治术(Miles手术)临床应用的初步探讨

Single-port access laparoscopic abdominoperineal resection:Initial experience

目的:总结单孔腹腔镜腹会阴联合直肠癌根治术(Miles手术)的初步临床经验。方法:分析2010年5月至2012年8月5例接受单孔腹腔镜腹会阴联合直肠癌根治术(Miles手术)患者的临床资料及手术效果。结果:除1例患者中转常规多孔手术外,其余4例均于单孔条件下成功完成。平均手术时间为193.8±44.6min(120-240min)。术中平均出血量为137.5±65.0ml(50-200ml)。肠蠕动功能恢复平均时间为4.3±1.2d(3-6d)。无输尿管、阴道损伤,无排尿功能障碍等并发症发生。术后病理均为直肠腺癌,切除标本断端未见癌,清除淋巴结无转移。pTNM分期为Ⅰ期(T2N0M0)1例,Ⅱ期(T3N0M0)3例,中转病例为Ⅳ期(T4N0M1)。结论:单孔腹腔镜腹会阴联合直肠癌根治术(Miles手术)是安全可行的,并且可以获得更好的微创及美容效果。与传统腹腔镜手术相比,其近远期的治疗效果还需多中心的临床随机对照试验证实。

Objective：To describe our initial experience with single-port access（SPA） laparoscopic abdominoperineal resection（APR）.Methods：Five selected patients underwent single-port access laparoscopic abdominoperineal resection.All the procedures were performed by using the rigid laparoscopic instruments.The clinical data and surgical outcomes were retrospectively reviewed.Results：Four cases were managed successfully using the SPA technique and conventional instrumentation.One operation was converted to standard laparoscopy,because the left ureter and vagina were involved by the tumor.Average surgery time was（193.8±44.6）min（120-240min）,and mean estimated blood loss was（137.5±65.0）ml（50-200ml）.The patients recovered bowel function on the average of 4.3±1.2d（3-6d）.The pathological reports described rectal adenocarcinoma without positive surgical margins or metastatic nodes.The pTNM status was stageⅠin 1 patient,stage Ⅱ in 3 patients and stage Ⅳ in the converted case.Conclusion：Single-port access laparoscopic abdominoperineal resection is safe and feasible with better surgical outcomes and cosmetic benefits in the hands of skilled laparoscopic surgeon.Comparisons between SPA and conventional laparoscopic abdominoperineal resection are needed to clearly identify the real benefits of this procedure.