腹腔镜联合折刀位直肠癌腹会阴根治术

Laparoscopic Miles operation with jackknife position for low rectal carcinoma

目的:探讨腹腔镜联合折刀位直肠癌腹会阴根治术(Miles手术)的可行性。方法:2008年6月至2010年7月为38例低位直肠癌及肛管癌患者施行腹腔镜腹会阴根治术,15例以常规截石位行腹腔镜手术(截石位组),23例先折刀位行会阴部手术,再取平卧位行腹腔镜腹部手术(折刀位组)。对比分析两组患者手术情况、术后开始下床活动时间、肠功能恢复时间、进半流质饮食时间、术后住院时间、并发症发生率、死亡率及30d再住院率。结果:折刀位组会阴部出血量少于截石位组,拔除腹腔引流管时间早于截石位组,两组患者术后开始下床活动时间、肠功能恢复时间、进半流质饮食时间、术后住院时间、并发症发生率差异无统计学意义,两组均无死亡病例。结论:腹腔镜联合折刀位直肠癌腹会阴根治术相对传统截石位手术会阴部出血及术后渗出更少,具有一定的优势。

Objective：To investigate the feasibility of laparoscopic Miles operation with jackknife position for low rectal carci- noma. Methods：From Jun. 2008 to Jul. 2010 38 patients with low rectal or anal canal carcinoma were treated with laparoscopic Miles operation. 15 of them received operation with fithotomy position （lithotomy group） , and 23 received perineal operation with jackknife position （jackknife group）. Operative information, time of postoperative out-of-bed activity, recovery of gastrointestinal function, semi-fluid food intake time, postoperative hospital stay, complication rates, mortality and rehospitalization rate during 30 d were observed. Results ： Blood loss of perineal position in jackknife group was less than those in lithotomy group. Removal of drainage tube in jackknife group was earlier than that in lithotomy group. There was no significant difference in time of postoperative out-of-bed activity, recovery of gastrointestinal function,semi-fluid food intake time, postoperative hospital stay and complication rates between 2 groups. No patients died in the 2 groups. Conclusions： The blood loss and postoperative exudation at perineal region in laparoscopic Miles operation with jackknife position is less than that in traditional lithotomy position. Laparoscopic Miles operation with Jackknife position is a better choice.