无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治的临床研究

Clinical research of laparoscopic radical resection for rectal cancer by pull-through operation without assistant incision

目的:探讨无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治的临床应用价值。方法:回顾性分析术前Dukes A期26例患者,行无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治术的临床病理资料,其中直肠癌Dixon术式21例,Miles术式5例。结果:26例直肠癌均在完全腹腔镜下完成手术,无死亡病例,上端切缘距肿瘤大于10cm,下端切缘大于3cm;病理均为腺癌,切缘无癌组织残留。术中出血量(15-310)ml,平均87.89ml;手术时间(109-297)min,平均173.45min;术后肠蠕动恢复时间(27-88)h,平均49.97h;术后住院(7-12)d,平均8.69d;淋巴结清扫(2-20)枚,平均12.3枚。术后有1例吻合口出血,无吻合口瘘和狭窄等并发症,术后短期随访局部复发l例,其他患者无复发、转移及trocar切口的种植转移。结论:无辅助切口完全腹腔镜下直肠外翻拖出式直肠癌根治手术是安全可行的,患者痛苦小,并发症少,可获最佳美容,术后恢复快,与常规开腹手术疗效相当。

Objective：To evaluate the value of laparoscopic radical resection for rectal cancer by pull-through operation without assistant incision.Methods： The clinical and pathological data of 26 patients with stage Dukes A was analyzed retrospectively.26 patients were preformed laparoscopic radical resection for rectal cancer by pull-through operation without assistant incision,among which 21cases by Dixon operation and 5cases by Miles operation.Results： All 26 patients were successfully preformed laparoscopic radical resection for rectal cancer.No one died during operation.The upper incision margin exceeded 10cm from the border of tumor and the lower incision margin exceeded 3cm.Histological type of 26 cases was adenocarcinoma.Postoperative pathological examination revealed no residual of cancer cells in stump.The intraoperative blood loss was（15-310）ml（mean 87.89ml） and operation time was（109-297） min（mean 173.45min）.The postoperative recovery time of intestinal peristalsis was 27-88h hours（mean 49.97 hours）.（2-20） lymph nodes were removed（mean 12.3） during operation.The postoperative hospital stay time was（7-12） days,with an average of 8.69 days.There was postoperative hemorrhage in 1 case without other operative complications such as anastomotic leakage and stenosis.No metastasis,recurrence or trocar incision implantation was found in the follow-up period except one patient with local recurrence.Conclusion： There is minimal suffering in laparoscopic radical resection for rectal cancer by pull-through operation without assistant incision,which is safe and feasible with good cosmetic efficiency,lower complications,and rapidly recovery.It can obtain almost the same benefits as the open operation.