应用腹腔镜行低位直肠癌根治术27例报告

Laparoscopic total mesorectal excision in low retal cancer:a report of 27 cases

目的 探讨腹腔镜全直肠系膜切除 (TME)治疗低位直肠癌的临床应用价值。方法 回顾性分析2 0 0 1～ 2 0 0 3年 2 7例腹腔镜低位直肠癌手术 ,其中Dixon术式 18例 ,Miles手术 9例。结果 2 7例手术成功 ,无中转开腹。平均手术时间 (16 0± 2 0 )min ,术中平均失血 (15 0± 15 )mL ,术后平均住院 7d。无术后出血、吻合口瘘 ,术后排尿障碍 1例 ,明显性功能障碍 2例。随访 1～ 2 7个月 ,随访率为 10 0 % ,1例腹腔转移 ,1例肝脏转移 ,无穿刺口及切口转移。结论 TME治疗低位直肠癌安全可行 ,且创伤小 ,疼痛轻 ,恢复快。掌握手术适应证及良好的腹腔镜手术技术和开腹直肠手术经验是手术成功的保证。

Objective To study laparoscopic total mesorectal excision in low rectal cancer. Methods Twenty-seven cases with low rectal cancer who underwent laparoscopic total mesorectal excision(TME)from 2001 to 2003 were reviewed. Eighteen cases underwent rectal anterior resection and 9 cases underwent abdominal perineal resection. Results Twenty-seven cases succeeded. The mean time of operation was (160±20) minutes.Average intraoperative bleeding was (150±15)mL. The mean postoperative hospital stay was 7 days. sex dystunction ouurred in two cases.Urinary retention occurred in one case. No other postoperative complications such as bleeding and leakage occurred. All patients were followed up 1-27 months.One case metastasized in liver and another in abdominal cavity.No implantation was found in the trocar holes and the incision of abdominal wall. Conclusion The laparoscopic total mesorectal excision for low rectal cancer is feasible and safe with less trauma、pain and rapid recovery. It must be performed under good indications by skilled and experienced surgeons.