腹腔镜直肠癌经肛门外翻切除吻合治疗体会

Experience of Laparoscopy Combined with Peranal Resection and Anastomosis in the Treatment of Rectal Cancer

目的 探讨腹腔镜Dixon术治疗中低位直肠癌的方法与疗效。 方法 对 3例中低位直肠癌患者行腹腔镜Dixon术 ,术中将结肠和肛管外翻切除吻合 ,腹部不另做切口 ,常规放置肛管和经腹腔镜操作孔放置盆底引流管。 结果 手术时间平均 170 (15 0～ 2 10 )min ,术后 1～ 2d胃肠道功能恢复并下床活动 ,术后住院时间平均 9(8～ 11)d。 3例病人全部痊愈出院 ,无吻合口瘘及排便功能异常。 结论 该手术安全可行 ,创伤小 ,疼痛轻 ,恢复快。术中不在腹腔断肠 ,减少了腹腔污染及种植转移危险 ,不在腔镜下腹腔内肠吻合大大降低费用。

Objective To evaluate the laparoscopic and peranal approach of Dixon procedure for low-and middle-positioned rectal cancer. Methods 3 cases of low-and middle-positioned rectal cancer underwent Dixon procedure via laparoscopic and percanal approach. The colon and anal canal everted to allow the tumor resection and anastomosis which was retracted into peritoneal cavity thereafter. No additional abdominal wall incision was needed. Drainage tube was routinly placed in pelvic floor and anal canal. Results The average operation time was 170 min(150～210 min), duration for recovey of bowel function was 1～2 days, average postoperative hospital stay was 9 days(8～11 d). All three patients recovered and discharged without anastomatic leakage and defecation dysfunction. Conclusions This approach is feasible with low risk, minimal invasion, less pain and rapid recovery. The risk of peritoneal cavity contamination and implantation metastasis can be greatly reduced resulting from extraperitoneal colon transection, and the cost will significantly lower by avoiding consumption of the endo-GIA.