腹腔镜辅助全直肠系膜切除术的手术难点

The difficult steps in laparoscopically total mesorectal excision

目的:探讨腹腔镜辅助全直肠系膜切除术(LATME)的手术难点。方法:收集2006年9月—2009年9月期间91例LATME的临床资料,总结手术规律和经验,对LATME的手术难点,进行归纳分析。结果:91例接受LATME的患者,除1例中转开腹,其余均顺利完成手术,无手术死亡,无严重的手术并发症。手术中应着重遵循以下几点:避免损伤输尿管;于肠系膜下动脉根部切断结扎肠系膜下动脉,清扫第三站淋巴结;找对层面进入骶前间隙;注意保护盆自主神经;直肠侧韧带的处理;合理确定肿瘤下切缘。结论:了解和体会LATME的手术难点,对顺利开展LATME,可能有所裨益。

Objective：To investigate the difficult steps in laparoscopically total mesorectal excision（LATME）.Method：According the dinical datu of 91 patients in september 2006 to september 2009,sume rule and expenence of operation were analyzed.To sum up the difficult steps of LATME.Results：Only 1 patient in the laparoscopic procedure was converted to laparotomy.There was no intraoperative mortality and no serious morbidity among the patients who underwent LATME.Some surgical steps should be paid attention on.To avoid injury of ureter.High ligation of the inferior mesenteric artery and D3 lymphadenectomy.Find the exact deck to presacral space.Pay attention to pelvic autonomic nerve preservation.The treatment of lateral ligament of the rectum.To ascertainment inferior border of tumour exactly.Conclusions：It could help to successfully carry out LATME and to fully understand difficult steps in LATME.