腹腔镜直肠癌根治手术65例分析

Analysis of Laparoscopic Surgery in 65 Cases with Rectal Cancer

[目的]探讨腹腔镜直肠癌全直肠系膜切除(TME)手术几个值得注意的问题。[方法]回顾性分析腹腔镜直肠癌TME手术65例。[结果]65例按TME原则采用腹腔镜完成直肠癌手术,Dixon手术58.5%(38/65),Miles手术30.8%(20/65),Parks手术10.8%(7/65)。手术时间130～300min,平均175min,术中平均出血量120ml。本组无吻合口瘘,无围手术期死亡病例。术后1～4d肠道功能恢复。[结论]腹腔镜直肠癌TME手术安全可行,术中应根据病情选择肠系膜下动脉切断位置、盆腔自主神经保留以及是否行保护性回肠造口。

[Purpose] To investigate several hot spots issues of laparoscopic surgery for rectal cancer. [Methods] Sixty-five cases with rectal cancer who underwent laparoscopic total mesoreeal excision （TME） surgery were analyzed retrospectively. [ Results ] Among the 65 cases undergoing laparoseopie TME surgery, 58.5%（38/65） was Dixon procedure, 30.8% （20/65） was Miles procedure, and 10.8% （7/65） was Parks procedure. The mean time of operation was 175min （range 130-300min）, and average operative bleeding was 120ml. No perioperation death and postoperative complications such as anastomotie leakage occurred. Recovery of intestinal function was 1-4d. [Conclusions ] The laparoscopic TME procedure for rectal cancer is safe and feasibility. The necessity of cutting off inferior mesenteric artery at a higher level, preservation of pelvic autonomic nerve, and protective ileostomy should be chosen accordingly.