经自然腔道完全腹腔镜超低位直肠癌保肛根治术疗效分析

The effect of natural orifice transluminal totally laparoscopic surgery of anus-preserving radical resection for ultralow rectal cancer

目的探讨经自然腔道完全腹腔镜超低位直肠癌保肛根治术的可行性及安全性。方法经肛门直视下在距癌灶最下缘1.5～2.0 cm处对肿瘤远端肠管缝合、切断,经肛门将肿瘤拖出切除,近端肠管置入吻合器钉座,缝合关闭远端肠管,术中冰冻病理检查确认远端切缘无癌细胞残留,再经肛门置入管状吻合器进行肠管端端吻合或手工吻合。结果 7例手术均获成功。手术时间145～265 m in,平均190 m in;术中出血45～95 m l,平均65 m l,术中无肠管、输尿管及邻近器官损伤。吻合口距齿状线1.0～2.0 cm,术后无吻合口漏及吻合口狭窄等并发症。术后3个月排便次数4～6次/d,随访3～16个月,未发现吻合口复发及穿刺孔种植转移。结论经自然腔道完全腹腔镜超低位直肠癌保肛根治术既能保证肿瘤远端肠管有足够的切除范围,又能避免腹部辅助切口,减少腹腔镜手术难度,在临床上具有一定的应用价值。

Objective To investigate the safety and feasibility of natural orifice transluminal totally laparoscopic surgery of anus-preserving radical resection for ultralow rectal cancer.Methods Through the anus,the distal rectum was sutured,dissected and closed at the level 1.5-2.0 cm away from the tumor site.The rectal cancer was subsequently pulled out through the anus,the anvil was then inserted transanally into the proximal rectum.The distal rectum was sutured.After no tumor cells at the margin of the resected rectal segment was confirmed by pathological examination,the tubular stapler was inserted transanally and followed by stapled end-to-end colorectal anastomosis,or by hand-sewn method.Results The operation period was uneventful.The mean operative time was 190 minutes（ranging from 145 to 265 minutes）,and mean blood loss was 65 ml（ranging from 45 to 95 ml）.No bowel,ureter or adjacent organ was surgically injured.The distance between anastomotic stoma and anocutaneous line was 1.0 to 2.0 cm.No complications of anastomotic leakage or stenosis were reported and the average defecation was 4 to 6 times per day during following up for 3 months.No complications of anastomotic recurrence or puncture implantation metastasis were reported during following up between 3 to 16 months.Conclusions Natural orifice transluminal totally laparoscopic surgery of anus-preserving radical resection for ultralow rectal cancer can not only ensure the oncological distal rectum excision without the need of abdominal incisions,but also reduce the difficulty of laparoscopic surgery.