精准解剖:腹腔镜腹骶联合切除在低位直肠癌根治术中的应用

Accurate anatomy: application of laparoscopic abdominosacral resection for low rectal cancer

目的:探讨腹腔镜腹骶联合切除术在低位进展期直肠癌中的应用价值。方法:回顾分析2011年3月至2012年2月为可行根治性切除且不能保留肛门的15例低位直肠癌患者行腹腔镜腹骶联合直肠癌根治术的临床资料,术后观察排尿及性功能情况。结果:患者术后均恢复顺利,无围手术期死亡病例,术中均无穿孔,术后环周切缘均为阴性,手术时间(包括术中翻身时间)平均(230.7±36.3)min,术后引流管拔除时间平均(6.0±1.0)d。术后发生会阴切口感染1例,经换药后愈合。排尿功能障碍发生率为13.3%,男性性功能障碍发生率30%。结论:腹腔镜腹骶联合切除术具有腹腔镜手术与腹骶联合手术的优点,应用于低位直肠癌可实现精准解剖,降低自主神经损伤率、标本环周切缘阳性率及术中直肠穿孔率。

Objective ： To explore the application of laparoscopic abdominosacral resection for patients with advanced low rectal cancer. Methods： Fifteen patients with advanced low rectal cancer were given laparoscopie abdominosaera[ resection. They were admit- ted in Linyi People~ Hospital from Mar. 2011 to Feb. 2012 and could not preserve anus. Urination and sexual function were observed af- ter operation. Results：Postoperative recovery was uneventful. There were no intra-operative bowel perforation and no circumferential re- section margin involvement in all 15 patients. The mean operative time （including intraoperative posture adjustment time） was （230.7 ± 36.3 ） min, the drainage tube was removed （6.0 ± 1.0） d after operation. The infection of perineum incision was found in 1 patient： and was cured after dressing change. Urination disorders rate was 13.3%. The rate of sexual dysfunction was 30%. The rates of urina- tion disorders and sexual dysfunction are similar to the reports in literature. Conclusions：Laparoscopic abdominosacral resection has the advantages of laparoscopy and alodominosacral resection. It can perform accurate anatomy in patients with advanced low rectal cancer, can reduce the injury rate of pelvic autonomic nerve,the positive_rate of circumferential resection margin and the intra-operative bowel perforation rate.