腹腔镜全直肠系膜切除保肛治疗直肠癌的临床应用

Clinical application of laparoscopic total mesorectal excision and anal sphincter preservation in the treatment for rectal cancer

目的:探讨腹腔镜直肠癌全直肠系膜切除(laparoscopic total mesorectal excision,LTME)保肛术的可行性、安全性、操作要点及治疗效果。方法:回顾分析39例腹腔镜直肠全系膜切除术患者的临床资料。结果:39例患者手术顺利,无中转开腹,手术时间为140～280 min,平均150 min;术中出血20～130 ml,平均40 ml;淋巴结清扫4～23枚,平均10.3枚。术后30～72 h恢复胃肠功能并下床活动,住院时间5～16 d,平均9 d。39例术后随访2～36个月,平均18个月,均未发现吻合口肿瘤复发及远处转移。结论:腹腔镜全直肠系膜切除保肛治疗直肠癌,除具有创伤小、出血少、保肛率高、术后疼痛轻、恢复快等优点外,对自主神经丛的保护更准确,术后肛门括约肌功能及排尿功能良好,是一项微创治疗直肠癌的技术。

Objective： To explore the feasibility,safety,operating essentials and therapeutic effect of laparoscopic total mesorectal excision with anal sphincter preservation in the treatment for rectal cancer.Methods： The clinical data of 39 cases with laparoscopic totalmesorectal excision were analyzed retrospectively.Results： 39 cases were successfully completed and none of the patients were converted to open surgery.The operation time was 140-280 min,the average of 150 min,and the intraoperative blood loss was 20-120 ml,the average of 40 ml.4-23 lymph nodes were resected,the average of 10.3 lymph.The postoperative convalescence of intestinal peristalsis was 30-72 hours,the average of 48 hours.The postoperative hospital stay was 5-16 days,with an average of 9 days.All the secondary damages were managed successfully with laparoscopy.No complications of anastomotic leakage occurred after the operation.Conclusion： Laparoscopic total mesorectal excision and anal sphincter preservation in the treatment for rectal cancer is a perspective minimally invasive technique,which is feasible,safe and effective.With the use of this technique,surgeons could accomplish higher rates of sphincter preservation,more accurate autonomic nerve preservation and good micturation with decreased postoperative pain and rapid recovery.