腹腔镜辅助下低位直肠癌扩大根治术的经验体会

Experience on laparoscopic assisted extended radical resection of low rectal cancer

目的探讨腹腔镜辅助下低位直肠癌扩大根治术的手术安全性、可行性和经验体会。方法选择2010年4月至2010年8月手术治疗的Duke's B期和Duke's C期的22例低位直肠癌患者的临床资料。进行腹腔镜直肠癌扩大根治术,其中男12例,女10例,肿瘤距齿状线(5±2)cm,Dixon式21例,Miles式1例,22例均未行保护性造口,外翻脱出肛门外切除吻合8例,骶前及腹腔对口引流15例,21例Dixon式患者均术后定期扩肛。结果 22例患者均在腹腔镜下完成切除手术,均保留盆腔自主神经,无中转开腹,无死亡病例,腹腔镜低位直肠癌扩大根治术平均手术时间为(200±40)min,平均总出血量(150±30)ml,无术后出血,吻合口瘘3例,排尿障碍1例(男性老年患者),无直肠阴道瘘的发生,成功关闭盆底腹膜3例,术后平均住院时间(9±4)d,平均检出肠系膜淋巴结20.2枚,下腔静脉前及左右髂总淋巴结8.3枚,左右闭孔及骶前淋巴结5.3枚。结论腹腔镜低位直肠癌扩大根治术能够达到开腹手术的效果,具有可靠的安全性和可行性,且疼痛轻,创伤小,恢复快,值得在临床推广应用。

Objective To investigated the feasibility and safety of laparoscopic assisted extended radical resection of lower rectal cancer,and to discuss about the experience. Methods Between April 2010 and august 2010,22 patients with Duke’s B and Duke’s C lower rectal cancer at our hospital were enrolled in this study. Including 12 males and 10 females,all of them underwent laparoscopic extended radical resection. The mean distance of tumor to dentate line were 5±2 cm,and we performed Dixon procedure for 21 cases and Miles for 1 case,and Pull-through anastomosis for 8 cases, peritoneal counterparts presacral drainage for 15 cases. None of the 22 patients underwent protective colostomy, all of the 21 cases of patients who underwent Dixon procedure performed a routinely anal dilation postoperatively. Results We completed laparoscopic extended radical resection of lower rectal cancer in all the 22 patients , with preservation of the pelvic autonomic nerve ,and with no conversion to open or no death cases.The average operation time of laparoscopic extended radical resection of lower rectal cancer was 200 ± 40 min, average total operation blood loss was 150± 30 ml, Through we find no postoperative bleeding and no incidence of rectovaginal fistula , anastomotic leakage occurrence in 3 cases, mean postoperative hospital stay were 9 ± 4 days, the average lymph nodes detected in 20.2, around the inferior vena cava before and 53 common iliac lymph nodes, obturator and presacral lymph nodes around 5.3 . Conclusions Laparoscopic extended radical resection of low rectal cancer is a feasible and safe procedure, can achieve the effect of open resection; With the advantages little pain、small trauma and quicker recovery, it worth clinical application.