腹腔镜低位直肠癌根治保留肛管手术的临床应用

Clinical application of laparoscopic conservative-proctectomy with anal mucosectomy in low rectal caner

目的探讨腹腔镜下全直肠系膜切除(TME)基础上保留肛管术治疗低位直肠癌的可行性和临床应用价值。方法对2007年5月～2008年3月经腹腔镜实施保留肛管手术的41例低位直肠癌患者的临床资料进行回顾性分析。结果 41例行保留肛管手术患者手术顺利,平均手术时间(110±32)min,术中平均出血量(15±18.5)mL,术后持续性胃肠减压8～48 h,肠蠕动恢复时间(24±17)h,术后1～3 d开始进食,术后1～3 d拔除导尿管并下床活动,平均住院时间为8 d。术后随访14～23个月,有15例患者出现前切除后综合证,3～6个月后症状消失,目前未发现转移复发病例。结论全系膜切除是直肠癌根治切除必须遵循的原则;经腹腔镜行保留肛管手术治疗低位和超低位直肠癌安全可行,且创伤小,出血少,手术疼痛轻,恢复快;经临床14～23个月随访,患者控制排便功能好,未发现肿瘤复发,近期疗效满意。

[Objectives] To report the laparoscopic operative experience and sphincter-preserving results of total mesorectal excision （TME） combined with laparoscopy of conservative-proctectomy with anal mucoseetomy. [Methods] From April 2007-June 2008, 41 cases of patients were performed conselwative-proctectomy with anal mucosectomy with laparoscopy. [Results] All of the operations were successfully completed. There was no death of operation occurred the patient were followed-up for 8 month to 20 month. The average operative time （l10±32） min, the amount of bleeding during operation was mean （15＋18.5）mL. The function of in testine was come to within mean （24±17） h. The average hospit,al stay was 8 d. There was no recurrence metastasis in the follow up of 8-20 months. Favorable anal function was reserved in 36patients. [Conclusion] Laparoscopic conservative-proctectomy with anal mucosectomy for rectal cancer has some advantages, such as little wound, few complication, blood loss and hospital stay and so on. It can be safely performed in ultra-low rectal cancer it preseres anal function well and offers radical cure.