腹腔镜全直肠系膜切除治疗低位直肠癌(附198例临床资料报告)

Laparoscopic rectal excision for low rectal cancer using total mesorectal excision(TME)

目的探讨腹腔镜全直肠系膜切除治疗低位直肠癌的可行性和安全性。方法回顾分析198例腹腔镜全直肠系膜切除治疗低位直肠癌病例资料。结果全组无手术死亡,无中转开腹。平均手术时间（211.5±69.2）min,中位出血量80（50～200）mL,平均切除淋巴结数为（11.5±6.4）枚,平均肛门排气时间（2.8±1.4）d,平均可下地行走时间（1.6±0.9）d,平均术后住院时间（11.8±6.4）d。术后并发症发生率为20.71%,最常见为肠梗阻（占并发症的24.4%）。中位随访时间为26.1（13.6～45.2）个月,随访率86.9%。33例出现术后复发转移,其中吻合口复发2例,盆腔局部复发3例,腹腔广泛转移4例,远处转移24例。死亡共37例,其中死于肿瘤相关因素28例,死于非肿瘤相关因素9例。5例带瘤生存。结论腹腔镜全直肠系膜切除治疗低位直肠癌不仅具有疼痛轻、恢复快等优点,在技术上也是安全可行的,而最终的结果仍有待于大量的、长期的前瞻性随机对照研究。

Objective To assess the feasibility and safety of totally laparoscopic total mesorectal excision for low rectal cancer. Methods A retrospective review of 198 patients underwent totally laparoscopic total mesorectal excision for low rectal cancer by a single surgeon was undertaken. Results Surgical operative morbidity was 0%. No patient required open conversion. Mean operative time was （211.5 ± 69.2 ）min. Median blood loss was 80（50.0-200.0）ml. Median number of lymph nodes yield was （11.5±6.4）. Mean time to pass flatus, time to ambulate and hospital stay were （2.8±1.4）d, （1.6±0. 9）d and （11.8±6.4） d. Total complication rate was 20. 71%. Bowel obstruction was the most common postoperative complication （24.4%）. Median follow-up time was 26.1（13.6-45.2） months. Follow-up rate was 86.9%. 33 recurrences and metastases had occurred which included 2 anastomotic recurrences, 3 pelvic recurrences, 4 abdominal cavity metastases and 22 distant metastases. There were 37 postoperative deaths, which included 28 cancer-related deaths and 9 deaths caused by other diseases. 3 patients are alive with disease recur- rence. Conclusion Laparoseopic total mesorectal excision for low rectal cancer has definite advantages such as less pain and quick recovery. It also appears to be safe and reliable technically. While the final conclusion need more and long-term randomized and controlled studies.