腹腔镜辅助经肛内镜直肠癌根治术的近期疗效

Short term effects of transanal endoscopic radical resection for rectal carcinoma with laparoscopic assistance

目的探讨腹腔镜辅助经肛内镜直肠癌根治术的安全性、可行性及近期效果,并探讨经肛内镜和经腹腹腔镜两者同步使用是否优于序贯使用。方法回顾性分析19例中下段直肠癌患者腹腔镜辅助经肛内镜直肠癌根治术及术后恢复情况,并将经肛内镜和经腹腹腔镜序贯进行(序贯组,前9例)和同步进行(同步组,后10例)进行比较。结果 19例平均手术时间(3.85±0.98)h,中位术中出血量为80(50,120)ml,平均检出21.89±9.21个淋巴结,术后首次下床活动时间(2.09±0.94)d,肛门功能恢复正常时间(7.95±3.49)d;16例系膜大体标本完整3例接近完整;有2例中转为腹腔镜辅助直肠癌根治术,2例吻合口漏,1例局部复发再次手术局部切除,无输尿管损伤、骶前大出血、腹腔感染、手术死亡。同步组与序贯组比较,平均手术时间[(3.39±0.96)hvs.(4.36±0.75)h]、术后首次下床活动时间[(2.10±0.99)dvs.(3.78±1.56)d]减少明显(P<0.05)。结论腹腔镜辅助经肛内镜直肠癌根治术较为安全可行,基本上不影响肿瘤根治性,经肛内镜和经腹腹腔镜两者同步使用较序贯使用手术时间更短恢复更快。

Objective To investigate the safety, feasibility and short-term outcomes of transanal endoscopic radical resection for rectal carcinoma with laparoscopic assistance, and to determine if synchronous use is superior to sequential use of transanal endoscopic and transabdominal laparoscopic procedure. Methods The clinical data of 19 patients with rectal carcinoma treated with the procedure were retrospectively analyzed,and the results of synchronous group （the latter 10 cases） were compared to what of sequential group （the former 9 cases）. Results Among 19 consecutive patients, two cases were conversed to laparoscopic procedure. The mean operative time, median blood loss, mean number of lymph nodes harvested, mean time of first ambulation, mean time of anal function recovery were （3.85±0.98）h, 80（50, 120）ml, （21.89±9.21）, （2.09±0.94） d, （7.95±3.49）d, respectively. Macroscopic evaluation of 16 specimens were classified as complete, 3 as nearly complete. Two patients developed postoperative anastomotic leakage. One patient encounted local recurrence and was treated with local R0 resection. There were no ureteral injury, presacral hemorrhage, abdominal infection and mortality. Compared to sequential group,the synchronous group showed significant decrease of operative time（3.39±0.96 vs. 4.36±0.75 h,P0.05）and mean time of first ambulation（2.10±0.99 vs. 3.78±1.56 d,P0.05）. Conclusion Transanal endoscopic radical resection for rectal carcinoma with laparoscopic Assistance is safe, feasible and radical, synchronous use is superior to sequential use of transanal endoscopic and transabadominal laparoscopic procedure.