直肠脱出技术在腹腔镜低位直肠前切除术中的应用

Prolapsing technique in laparoscopy-assisted low anterior resec- tion

目的探讨直肠脱出技术在腹腔镜低位直肠前切除术中应用可行性与治疗效果。方法回顾性分析2005年10月至2007年3月上海微创外科临床医学中心为9例低位直肠肿瘤病人运用直肠脱出技术行腹腔镜低位直肠前切除术的临床资料，研究其手术操作、术后恢复、肿瘤根治性效果及随访结果。结果男6例，女3例，平均年龄58（40～75）岁。腺瘤2例，Ⅰ期病例6例，Ⅱ期1例。所有病例无术中严重并发症和手术死亡，无中转开腹手术；平均手术时间195（150～232）min、平均术中出血55（25～100）ml，病人术后排气时间、留置导尿管时间和术后住院天数分别为2（1～4）d，7（5—10）d和11（7～20）d。清扫淋巴结总数12（9～20）枚，肿瘤距下切缘距离为1．6（1．0～3．8）cm。无严重术后并发症。随访12（4—21）个月，无局部复发和远处转移，排便功能恢复较满意。结论直肠脱出技术运用于腹腔镜低位直肠前切除术安全有效，符合肿瘤根治原则，且能获得较满意的排便功能恢复。

Objective To assess the feasibility and outcome of prolapsing technique in laparoscopy-assisted low anterior resection for low rectal tumor. Methods The technique of operation, status of recovery, complications, oncological clearance and results of short-term foflow-up were studied in 9 patients underwent laparoscopy-assisted low anterior resection with a prolapsing technique for low rectal tumor between Oct. 2005 and Mar. 2007. Results No case was converted to open surgery. The mean operative time was 195 （ 150 -232） min and the blood loss was 55 （25 ~ 100） ml. The mean time for passage of flatus, duration of urinary drainage, and that of postoperative hospital stay were 2 （ 1 ~ 4） d ,7 （5 - 10 ） d and 11 （7 - 20） d respectively. The total number of lymph nodes harvest was 12 （9 - 20）, and the mean distal margin from the tumor was 1.6 （ 1.0 - 3.8） cm. No major complication was observed. The mean foflow-up time was 12 （4 - 21 ） months. No local recurrence or metastasis was observed. Acceptable anal function results were obtained in most patients. Conclusion Laparoscopy-assisted low anterior resection with a prolapsing technique can be successfully performed.