腹腔镜手术在直肠癌局部复发治疗中的应用

Application of laparoscopic surgery for locally recurrent rectal cancer

目的探讨应用腹腔镜手术治疗直肠癌局部复发的可行性。方法 2006年1月至2009年6月对收治的11例直肠癌术后复发患者施行腹腔镜手术,男7例,女4例,平均年龄(55.1±9.9)岁。其中3例为开腹Dixon术后复发,6例为腹腔镜Dixon术后复发,2例为腹腔镜Miles术后复发。平均复发间隔(24.9±11.0)个月。结果本组11例患者手术均获成功,平均手术时间(212±42)min,术中出血量(133±75)ml,住院时间(13.5±7.6)d。无腹腔出血、吻合口漏等严重并发症发生,无围手术期死亡病例,2例中转开腹手术。9例行Dixon术后复发的患者中,1例再次行腹腔镜下Dixon术;4例行腹腔镜下腹会阴联合切除术;1例行腹腔镜下后盆腔脏器联合切除术;1例行腹腔镜下双侧附件切除术;1例行腹腔镜乙状结肠造口术;1例中转开腹行乙状结肠造口术。2例行腹腔镜Miles术后复发的患者,1例行腹腔镜下盆腔肿块切除术,1例因肠管粘连中转开腹行盆腔肿块切除术。结论选择合适的直肠癌术后复发病例施行腹腔镜再手术是安全可行的。

Objective To investigate the feasibility of the laparoscopic surgery for locally recurrent rectal cancer. Methods From January 2006 to June 2009,11 cases with locally recurrent rectal carcinoma treated by laparoscopic surgery were retrospectively analyzed. Among them, 7 were males and 4 females, and the average age was （ 55.1 ± 9.9 ） years. Three cases of recurrence underwent open anterior resection for primary tumor, 6 laparoscopic anterior resection and 2 laparoscopic abdominoperineal resection. The average interval for local recurrence was （ 24.9 ± 11.0 ） months. Results The mean operation time was （ 212 ± 42 ） min, the mean bleeding was （ 133 ± 75 ） ml and the mean hospital day was （ 13.5 ± 7.6 ） d. No complication and perioperative mortality occulted. Two patients convert to open surgery. The follow laparoscopic procedure were performed in 9 locally recurrent cases who underwent Dixon procedure for primary tumor： 1 laparoscopic anterior resection, 4 laparoscopic abdominoperineal resection, 1 laparoscopic posterior pelvic exenteration and 1 laparoscopic bilateral adnexectomy, 1 laparoscopic sigmoid colostomy and 1 convert to open sigmoid colostomy. One patient received laparoscopic pelvic mass resection and1 convert to open pelvic mass resection in 2 cases who underwent Miles procedure for primary tumor. Conclusions Laparoscopic surgery for locally recurrent rectal cancer is safe and feasible in selected patients.