经腹腔镜经肛门括约肌间直肠切除结肠肛管吻合术治疗超低位直肠癌13例

Laparoscopic Ultra-Low Anterior Rectal Resection Combined with Per Anus Intersphincteric Rectal Dissection for Ultra-Low Rectal Cancer

目的探讨经腹腔镜经肛门括约肌间直肠切除结肠肛管吻合术对超低位直肠癌保肛手术的治疗效果。方法从2005年6月到2007年12月期间对13例患者施行该手术。其中男8例,女5例,平均年龄53岁(41～69岁)。肿瘤距离肛缘均小于5cm。结果13例手术全部成功,无手术死亡,无吻合口漏发生。随访时间为1～30个月,平均随访17个月,1例盆腔复发,1例肝转移;无戳孔种植转移,术后6个月肛门括约肌功能达优良者9例。结论经腹腔镜经肛门括约肌间直肠切除结肠肛管吻合术是治疗超低位直肠癌的一种微创、安全、疗效可靠、肛门括约肌功能满意的较理想保肛手术。

Objective To approach the curative effect of laparoscopic rectum resection combined with per anus intersphincteric rectal dissection and colo anal anastomosis for patients with ultra-low rectal cancer. Methods Thirteen patients were prospectively studied from June 2005 to December 2007. There were 8 male and 5 female patients, with a mean age of 53 （range, 41-69） years. All the tumors located less than 5 cm above the anal verge. All the patients were treated with general anaesthesia and then went through the following procedures： lied the reverse Trendelenburg reforming lithotomy position, the laparoscope went inside the abdomen through two apertures, the hylus aperture （observing aperture） and the MeBurney point aperture （main performing aperture）. After the resection through the laparoscope, the operation was translocated to the perineal region, the anus was enlarged to expose the operation area. Results The operation on all cases succeeded, there was no operative mortality, and no stomal leak in all patients. The follow-up duration ranged from 1 to 30 months （mean 17 months）. Up to now, one patient developed recurrence in pelvic cavity, and one suffered hepatic metastasis, there was no port-site implanta tion metastasis, 9 patients had satisfactory functional recovery of anus in the sixth month after operation. Conclusion The therapy laparoscopic rectum resection combined with per anus intersphincteric rectal dissection and colo anal anastomosis for patients with uhra-low rectal cancer is a safe, minimally invasive, anal-preserving technique with reliablity in curative effect and satisfaction in anal sphincter function.