肛外手工吻合在腹腔镜低位直肠癌保肛术中的应用

Application of manual anastomosis out of anus in the laporoscopic anal sphincter preserving resection of low rectal cancer

目的探讨肛外手工吻合技术在腹腔镜低位直肠癌保肛术中的应用价值。方法应用超声刀在腹腔镜下对15例低位直肠癌患者实施全直肠系膜切除原则的根治性手术,用肛外手工吻合的方式完成超低位结肠-直肠/肛管吻合术。结果15例患者手术经过均顺利,无中转开腹。术后发生吻合口瘘1例,无腹腔出血、感染、吻合口狭窄等并发症。手术时间125～270min,平均156min。术中出血30～180ml,平均70ml。住院时间9～14d,平均11d。15例术后随访2～37个月,平均14个月。术后局部无复发,远处肝转移1例。结论低位直肠癌行腹腔镜下超低位切除、肛外手工吻合保肛术是一种安全、经济、创伤小、疗效可靠的术式。

Objective To explore the values of the manual anastomosis out of anus in the laparoscopic anal sphincter preserving resection of low rectal cancer. Methods Radical excision of low rectal cancer was performed laparoscopically with ultrasonic scalpel on 15 patients based on the concept of TME and ultralow coloreetal/anal anastomosis was performed by applying the manual anastomosis out of anus. Results All the operations were finished successfully without conversions to open surgery. One case had anastomotie leakage, and there were no bleeding and infection of abdominal cavity, anastomotic stcnosis and other complications. The operating time was 125 -270 min （mean 156 min）. The blood loss was 30 - 180 ml （mean 70 ml）. The length of hospital stay was 9 - 14 days （mean 11 days）. All patients were Followed up for 2 -37 months （mean 14 months）. Local recurrence was not found,and 1 case had liver metastasis. Conclusion The manual anastomosis out of anus in the laparoscopie anal sphincter preserving resection of low rectal cancer is safe, economical, effective and minimally invasive.