中间入路腹腔镜下直肠癌高位前切除术回顾分析

Laparoscopy-high anterior resection with a medial-to-lateral approach:clinical analysis of 26 cases

目的探讨中间入路在腹腔镜辅助下直肠癌高位前切除手术中的操作技巧、应用价值及并发症情况。方法对术中使用中间入路作为显露和操作的26例肿瘤下缘在肛门口以上超过10cm的直肠上段癌和乙状结肠下段癌的临床资料进行总结分析。结果手术均获得成功,平均手术时间为(110.3±43.8)min,术中平均出血量为(71.7±88.8)ml。发生术后并发症2例,发生率为7.8%,其中切口感染1例,肠梗阻1例。患者平均住院天数为(13.53±9.23)d,切除淋巴结(13±34)枚。经石蜡标本病理检查证实,除1例为绒毛管状腺瘤、1例为类癌、余24例均为腺癌。其中,按TNM分期,Ⅰ期8例,Ⅱ期11例,Ⅲ期7例。所有病例均获随访1～15个月,有1例局部复发但无远处转移,无肿瘤相关死亡病例。结论中间入路腹腔镜辅助下直肠癌高位前切除手术是安全有效的手术径路。但采用该手术径路是否能达到与传统手术相同的肿瘤根治性仍有待进一步验证。

Objective To introduce the standard procedure of laparoscopy-high anterior resection with a medial-to-lateral （ MtL ） approach and evaluate the complication and clinical value of this approach as an important exploration in the surgery of the laparoscope in radical resection for colorectal cancer. Methods The clinical data of 26 patients with colorectal carcinoma underwent laparoscopic operation with medial-to-lateral approach were analyzed retrospectively. Results 26 patients successfully underwent laparoscopic colorectal operation with medial-to-lateral approach. The mean operative time was （ 110.3 ±43.8 ） minutes and the average blood loss was （ 71.7 ±88.8 ） ml. Postoperative complications occurred in 2 patients, the incidence was 7.8 % . There were 2 patients suffering from complications including wound infection in 1 case, intestinal obstruction in l case. The average number of hospitalization days of patients was （ 13.53 ± 9.23 ） d. A mean of （ 13 ± 34 ） lymph nodes were reseeted. Pathological examination confirmed that, in addition to 1 case was tubulovillous adenoma, 1 case of carcinoid tumor, 24 cases were adenocarcinoma over. Among them, according to TNM staging, Ⅰ period of 8 cases, Ⅱ period of 11 cases,Ⅲperiod of 7 cases. Follow-up was achieved in 26 cases for 1 to 15 months, during which 1 patients had local recurrence. There was no distant metastasis cases and tumor-related deaths case. Conclusions The findings indicate that laparoscopy-high anterior resection using the MtL approach is a feasible and safe procedure for the treatment of curable colorectal cancer. However, whether the adoption of the surgical approach can achieve the same tumor with traditional radical surgery has yet to be further verified.