超低位直肠癌腹腔镜辅助下经肛门拖出吻合术(附21例报告)

Laparoscopic sphincter-saving resection for ultra-low rectal carcinomas

目的探讨腹腔镜下经肛门拖出式保肛手术在超低位直肠癌治疗中的应用。方法对21例行经肛门拖出式腹腔镜超低位直肠癌保肛手术病人的临床资料进行回顾性分析。结果本组平均手术时间为(200±40)min,平均出血量为(40±10)ml。术中发现吻合口瘘1例;术后发生吻合口瘘2例,吻合口狭窄2例,术后出血4例,盆腔感染4例。术后随访21例,随访时间为5～50月。行超低位吻合的13例6个月内排便正常,行结肠肛管吻合的8例9个月内排便正常。本组无局部复发病例,发生肝转移2例。结论腹腔镜下经肛门拖出式超低位直肠癌保肛手术确实可行,对于中、早期及组织学分型好的超低位直肠癌病人是较好的选择。

Objective To investigate the clinical application of laparoscopic sphincter-saving resection in ultra-low rectal carcinomas. Methods Twenty-one cases of ultra-low rectal cancers undergoing laparoscopic sphincter resection were analyzed. Results The mean operative time was（200 ± 40） min. Average intraoperative blood loss was（40 ± 10）ml. Intraoperative anastomotic stomal leakage occurred in 1 case, postoperative stomal leakage in 2 cases, stoma stenosis in 2 cases, postoperative bleeding in 4 cases, pelvic infection in 4 cases. Patients were followed up for 5-50 months. Defaecation function restored in 6 months in patiens subject to Dixon＇s surgery and 9 months in those to coloanal anastomoses. No local recurrence was found. Two cases had liver metastasis. Conclusion Laparoscopic sphincter-saving resection for ultra-low rectal cancer is feasible, and is a good choice for patients with ealy stage and well-differentiated cancers.