直肠外翻技术在腹腔镜低位直肠手术中的应用

Application of Rectal Eversion in Laparoscopic Low Rectal Operation

目的探讨直肠外翻技术在腹腔镜低位直肠手术中的安全性、可行性及操作要点。方法 2007年8月～2009年8月,对14例低位直肠病变[直肠癌7例（伴肝转移1例）,家族性腺瘤性息肉病4例,溃疡性结肠炎3例]施行直肠外翻技术联合腹腔镜手术,采用已击发的圆形端端吻合器来外翻直肠残端。14例均行一期吻合、预防性回肠造瘘。结果 14例均在腹腔镜辅助下完成,无中转开腹,无手术死亡病例。14例直肠残端均外翻成功。术后炎性肠梗阻1例,吻合口狭窄1例。7例直肠癌随访11～25个月（中位时间18个月）,未发现局部复发,术前合并肝转移者术后3个月再次出现肝脏新发病灶,其余6例未发现远处转移。7例非直肠癌术后随访9～33个月（中位时间19个月）,未见肠管新发病灶。所有病例术后排尿控制功能良好,造瘘还纳术后肛门控便、控气功能良好,男性病人未出现明显性功能障碍。结论直肠外翻技术联合腹腔镜手术在准确、安全切除病灶的前提下,既满足了微创的要求,又降低了手术费用;用已击发的圆形端端吻合器外翻直肠残端,简单且有效。

Objective To investigate the safety,feasibility and surgical procedures of rectal eversion technique in laparoscopic low rectal operation. Methods Rectal eversion combined with laparoscopic operation was performed on 14 cases of low rectal lesion,including 7 cases of rectal cancer（1 case was complicated with liver metastasis）,4 cases of familial adenomatous polyposis,and 3 cases of ulcerative colitis,from August 2007 to August 2009.Fired circular end-to-end anastomosis was used to evert rectal stump.One stage anastomosis and prophylactic ileostomy were conducted in all the cases. Results The operation was laparoscopically conducted in all the 14 cases,without conversion to open operation.No fetal case was encountered.The 14 cases of rectal stumps were all everted successfully.One case developed postoperative inflammatory intestinal obstruction and one case showed anastomotic stenosis.Follow-up in the 7 cases of rectal cancer for 11-25 months（median,18 months） showed no local recurrence but 1 case of distal metastasis.Postoperative follow-up of the other 7 cases for 9-33 months（median,19 months） showed no new lesion.All the cases had neither urinary incontinence nor anal incontinence after stoma closure operation.No apparent sexual dysfunction was observed in male cases. Conclusions Rectal eversion combined with laparoscopic operation can achieve the goals of mini-invasive operation as well as decreasing the operation cost under the precondition of excising lesion accurately and safely.With fired circular end-to-end anastomosis evert rectal stump is easy and efficient.