腹腔镜辅助经前会阴超低位直肠前切除术首例报道

Laparoscopic-assisted anterior perineal plane for ultra-low anterior resection of the rectal cancer （APPEAR）

目的 报道1例腹腔镜辅助经前会阴超低位直肠前切除术（APPEAR）的临床资料.方法 2010年10月12日,北京协和医院基本外科对1例新辅助放化疗后的低位直肠癌患者予以腹腔镜辅助APPEAR手术.手术首先经腹腔镜进行传统全直肠系膜切除：然后于会阴中部做一新月形皮肤切口,经前会阴入路在直视下使刚电刀游离被肛提肌包围的远端直肠及远端直肠系膜,于齿状线上1 cm离断直肠,采用双吻合器技术完成直肠-直肠端端吻合.结果 本例手术时间195min,其中会阴部手术时间30 min,术中失血50 ml.术后3 d结肠造口排气,第6天拔除盆腔引流管,第7天痊愈出院.术后病理示直肠黏液腺癌,侵及浅肌层.随访3周未见盆腔感染、吻合口瘘、切口感染等并发症.结论 腹腔镜辅助APPEAR手术治疗低位直肠癌围手术期安全可行.

Objective To report a case of APPEAR performed using a laparoscopic-assisted approach. Methods A laparoscopic-assisted APPEAR was performed with end-to-end anastomosis on October 12, 2010 for a patient with low rectal cancer who received neoadjuvant chemoradiation. After total mesorectal excision was completed laparoscopically, a crescent-shape incision was then made in the middle perineum. The distal part of the rectum was dissected with electrocautery. An double-stapling endto-end anastomosis was performed after transaction of the rectum. Results Total operative time was 195minutes. The perineal approach cost 30 minutes. The estimated blood loss was 50 ml. First stoma output with flatus was on postoperative day 3, and the patient resumed liquid diet. The patient was discharged on postoperative day 7. There were no complications including pelvic sepsis, perineal infection, or anastomotic leak. Conclusion The APPEAR procedure can be performed safely with the abdominal approach completed laparoscopically.