腹腔镜TME、MCME与低位/超低位/结-肛吻合术治疗下段直肠癌的临床应用研究

Total or Major Mesorectal Excision and Low/Ultralow/Colo-anal Anastomoses under

目的 :探索腹腔镜全直肠系膜切除 (TME)大部直肠周围系膜切除 (MCME)、低位 /超低位 /结肠 -肛管吻合术治疗下段直肠癌的可行性。方法 :按TME原则、用双钉合技术 (DST) ,在腹腔镜下对 2 0例下段直肠癌患者实施TME、DST低位 /超低位吻合术。结果。 2 0例患者手术顺利 ,无中转开腹 ,手术时间 140分钟～ 32 0分钟 ,平均 185分钟 ;术中出血 5～ 80ml,平均 2 5ml;术后 1～ 2天恢复胃肠功能并下床活动 ,住院时间 5～ 14天 ,平均 9天。术后止痛剂应用 7例 ,术中及术后无并发症发生。结论 :腹腔镜TME/MCME、低位 /超低位 /结 -肛吻合术治疗下段直肠癌 ,创伤小、保肛率高、术后疼痛轻、恢复快 ,是一极具应用前景的微创新技术。

Objective:To assess the feasibility and adequacy of a totally laparoscopic total mesorectal excision(TME),major circumferential mesorectal excision(MCME)and low/ultralow/colo anal anastomoses for low rectal cancer.Methods:Excision of the mesorectum and low/ultralow site anastomoses were performed through laparoscope on 20 patients with low rectal cancer based on the concept of TME and double stapling technique(DST).Results:20 TME/MCME and DST were successfully completed totally through laparoscope,and no one was converted to open procedure.The operation time was 185 min(140～320).Operative blood loss was 25ml(5～80).The time of bowel function returned and the time to resume post operative diet was 1～2 days after the operation.Seven patients required postoperative analgesic measures.Average hospital stay was 9 days(5～14)and there were no intraoperative or postoperative complications in all the 20 patients.Conclusions:Total laparoscopic excision of the mesorectum and low/ultralow/colo anal anastomoses for low rectal cancers is a perspective minimally invasive technique,and is feasible,safe,effective,rapid recovery,and dramatically higher rates of sphincher preservation with decreased postoperative pain.