腹腔镜技术和改良Parks手术在低位直肠癌保肛术中的应用

Laparoscopic surgery and Parks surgery modified for low rectal cancer

目的探讨应用腹腔镜技术和改良Parks手术治疗低位直肠癌的安全性及有效性。方法回顾分析2007-05～2010-02我院应用腹腔镜技术和改良Parks手术治疗低位直肠癌16例患者的临床资料。结果 16例手术均顺利完成,手术时间(161.2±55.4)min,术中出血量(144.7±94.5)ml,术后肛门排气时间(3.2±0.8)d,术后腹腔引流量(190.2±67.3)ml。术后出现吻合口瘘1例,经保守治疗好转,无输尿管损伤、排尿障碍及大便失禁等并发症。术后随访14例,时间为1～31个月,中位随访时间为14个月;失访2例。手术后大便次数增加7例,均在1年左右恢复至近正常状态。1例C期患者于术后9个月结肠镜检发现局部复发需行第二次手术,其他病例未发现复发、转移。结论短期结果提示应用腹腔镜技术和改良Parks手术治疗低位直肠癌是安全、有效的。

Objective To study the safety and feasibility of laparoscopic surgery and Parks surgery modified for low rectal cancer. Methods The patients＇ clinical data of laparoscopic surgery and Parks surgery modified for low rectal cancer was analysed retrospectively in our hospital between May 2007 and February 2010. Results Sixteen cases were selected in this study and all surgery was performed successfully. The average operative time was（ 161.2 ± 55.4） min, the mean volume of bleeding was （ 146.7 ± 94.5 ） ml, postoperative time of bowel gas passage was （3. 2 ±0. 8）d, the volume of abdominal drainage was （ 190. 2 ±67. 3）ml. One cases experienced anastomotic leakage and got recovery by conservative treatment. No other complications were experienced, such as ureteral injury, dysuresia, fecal incontinence, and so on. The time of following up ranged from one to thirty-one months and the median number was fourteen. Two cases were lost during following up. Seven eases suffered increased frequency of stool and all these patients got normal stool within one year. One case had to accept second surgery for recurrence. It was found by en- doscopic examination at postoperative ninth month. No recurrence and matestasis were found in other cases. Conclusion This short-term study reveals that it is safe and efficient to perform laparoscopic operating and Parks surgery modified for low rectal carcinoma.