腹腔镜经肛拖出直肠癌根治术超低位保肛65例回顾分析

Retrospective analysis of laparoscopic transanal pull-through with anal sphincter preservation in the treatment of ultra-low rectal cancer

目的探讨腹腔镜下经肛拖出直肠癌根治术超低位保肛的可行性、安全性、根治性及短期临床疗效。方法回顾该院运用腹腔镜经肛拖出直肠癌根治术行超低位保肛的65例直肠癌患者资料,分析术中、术后及预后各项指标。结果 65例患者手术均获成功。平均手术时间(138±71.6)min,出血量(107.5±86.5)mL,平均淋巴结清除数(11.0±4.3)个,术后肠道功能恢复时间(2.3±0.6)d,止痛药物使用时间(1.8±0.7)d,住院时间(12.3±2.4)d,吻合口漏6例,吻合口出血2例,吻合口狭窄2例;术后随访中位数33个月(24～46个月),复发4例,转移6例,总生存率84.6%(55/65),目前未发现有穿刺孔转移及大便失禁。结论该手术方式符合肿瘤学根治性原则,安全可行,更微创,术后恢复快,适合用于超低位直肠癌保肛。

[Objective] To explore the feasibility, safety, radical cure and short-term outcome of laparoscopic transanal pull-through （LTPT） with anal sphincter preservation in the treatment of ultra-low rectal cancer. [ Methods ] Retrospective analysis of 65 ultra-low rectal cancer （〈5 cm from the anal verge） patients, from March 2006 to March 2008, which were subjected to LTPT with ana sphincter preservation. The operative procedures, elinicopathological data and short-term outcomes were collected and analyzed. [Results] The 65 cases operation successfully. The mean time for operation is （138±71.6） min, the mean volume of bleeding is （107.5±86.5） mL, the mean number of lymph node were cleared is （11.0±4.3）, the day for intestinal functional recovery is （2.3±0.6）, the day for acesodynes used is （1.8±0.7）, length of stay is （12.3±2.4） days, 6 eases occurred anastomotie leakage, 2 cases occurred anastomotic anastomotic bleeding, 2 cases occurred anastomotic stenosis, the median months for follow-up is 33 （24 months-46 months）, 4 cases occurred recurrence, 6 cases occurred metastasis, overall survival rate is 84.6% （55/65）, no fecal incontinence and puncture pore metastasis were observed. [Conclusion] LTPT with anal preservation can strictly follow oncologic principle, which is a safe and feasible approach to the surgical treatment of ultra-low rectal cancer, and has benefits of much less trauma and earlier postoperative recovery.