腹腔镜超声刀联合应用下直肠癌全直肠系膜切除术

TOTAL MESORECTAL EXCISION WITH ULTRASONIC SCALPEL UNDER THE LAPAROSCOPE IN THE OPERATION OF RECTAL CARCINOMA

目的介绍在腹腔镜下联合应用超声刀行直肠癌全系膜切除术。方法在腹腔镜下联合超声刀进行直肠癌全系膜切除术（ＴＭＥ）３例，术中循盆筋膜壁层和脏层的界面，在自主神经干的内侧进行，用超声刀锐性解剖切除直肠系膜，产生一个不间断的整体标本。结果３例患者恢复良好，术中无脏器损伤，平均出血量１００ｍｌ。术后均未使用止痛药，肠道功能恢复均在２４小时之内，住院时间平均为１０．３天。４个月后随访，生存质量良好，无复发和转移。结论腹腔镜下进行ＴＭＥ手术是微创外科运用于直肠癌的新进展，较传统开腹手术有一定的优势，但技术要求高，费用较贵。

Objective To introduce the total mesorectal excision (TME) under the laparoscope and with the ultrosonic scalpel. Methods Under the laparoscope and with the ultrosonic scalpel, total mesorectal excision in 3 patients . was performed. In operation, alone the parietal layer of pelvic fascia and inside the automatic nerve trunk, the mesorectum was excised with the ultrasonic scalpel. Results Three patients got final recovery, no damage to the viscera in operation occurred. Average hemorrhage amount was about 100ml. Intestinal function recovered within 24 hours, average in hospital time was 10. 3 days. After 4 months, 3 patients got good living quality without recurrence and metastasis. Conclusion TME under the laparoscope is a new progress of less damageable operation. Compared with the traditional open laparotomy,it has some advantage. But it requires high technology and expensive equipments, and the case is still very limited in use.