腹腔镜治疗直肠癌术后复发的初步经验

Experience of laparoscopic salvage surgery for locally recurrent rectal cancer

目的探讨直肠癌根治术后复发腹腔镜再手术的可行性。方法2004年2月至2005年7月间直肠癌术后复发腹腔镜再手术病例7例,其中男4例,女3例,中位年龄60(37～74)岁。术前CT等评估直肠癌复发为局部复发,排除远处转移。其中3例为传统Dixon术后,2例腹腔镜Dixon术后,1例腹腔镜Parks术后,1例3次经骶局部切除并有骶部瘘;手术采用腹腔镜辅助和腹腔镜手辅助技术。结果再手术中6例为中央型,手术均为R0,分别为腹腔镜Dixon术3例,腹会阴联合切除1例,后盆腔清扫1例,结肠全切末端回肠造口1例(家族性息肉病)。1例复合型,行腹腔镜乙结肠造口。腹腔镜手辅助2例。手术时间(211±13)min,出血量(200±91)ml,无中转开腹,无吻合口漏等并发症发生,住院时间(15±10)d。结论直肠癌复发再手术困难,操作者应具有丰富的腹腔镜技术和直肠手术经验,并选择中央型等适当病例的条件下可行。

Objective To investigate the feasibility of the laparoscopic salvage surgery for locally recurrent rectal cancer. Methods Seven cases with recurrent rectal carcinoma treated by laparoscopic salvage surgery from February 2004 to July 2005 were retrospectively analyzed. Among them, four were males and 3 females, and the median age was 60 years （ range 37-74）. Three cases of recurrence were after conventional anterior resection, 2 after laparoscopic-assist anterior resection, 1 after laparoscopic-assist Parks＇ procedure, and 1 with pars sacralis fistula after persacro-local resection for three times. Image examination （CT scanning） was taken preoperatively to evaluate the locally recurrence and exclude the distant metastases. The laparoscopic-assist procedure with or without a hand-assist technique was used in this study. Results Six cases with the recurrent lesion of central type were treated by salvage surgical procedure as follows： 3 laparoscopic-assist anterior resection, 1 laparuscopic-assist abdominoperineal resection, 1 laparoscopic-assist posterior exenteration, and 1 laparoscopic-assist proctocolectomy with a terminal ileum stoma. All of them were R0 resection confirmed by postoperative pathological examination. The other one with the lesion of combination type was treated with the procedure of laparoscopic-assist sigmoid colostomy. A hand-assist technique was used in 2 cases. The mean operation time, bleeding and hospital day was （211 ± 13 ） min, （200 ± 91 ） ml, and （ 15 ± 10） d, respectively. No conversion and complication occurred. Conclusion Laparoscopic salvage surgery for locally recurrent rectal cancer is safe and feasible when taken by experienced laparoscopic colorectal surgeon to the cases with the recurrent lesion of central type.