腹腔镜直肠全系膜切除术

Laparoscopic total mesorectal excision for rectal cancer

目的探讨腹腔镜外科技术在直肠全系膜切除术(TME)的应用。方法对39例腹腔镜直肠全系膜切除术患者进行随访和回顾性分析。结果腹腔镜直肠前切除术30例,中转手术1例;腹腔镜辅助Miles手术9例。无手术死亡,术中盆底静脉丛破裂出血1例(发生率2.6%)。平均手术时间185min,平均出血量85ml,平均术后住院日为8.5d。术后发生吻合口瘘1例,尿潴留1例。39例患者术后随访1～28个月,仅1例DukesC1期的低分化腺癌患者,术后12个月盆腔局部肿瘤复发。全组患者的trocar穿刺孔及腹壁切口无肿瘤种植。结论腹腔镜直肠全系膜切除术创伤小、疼痛轻、恢复快。只要严格掌握手术适应证,正确应用腹腔镜技术就能完成此类手术。

Objective To evaluate the application of laparoscopic surgery for total mesorectal excision (TME). Methods Thirty nine cases with rectal cancer underwent laparoscopic total mesorectal excision from July 1999 to November 2001.The patients were registered and followed up. Results Thirty cases received laparoscopic anterior rectectomy,one patient required open operation finally, and 9 laparoscopic assisted Miles operation.No patient died of operation, only one patient suffered from bleeding of venous plexus of pelvic cavity (2 56%). The mean operative time was 185 min, the mean blood loss was 85 ml, and the mean postoperative hospital stay was 8 5 days.One patient was complicated with anastomosis fistula and another uroschesis after the operation. All the patients were followed up from 1 to 28 months. Local pelvic recurrence was found in one patient after 12 months, who was in Dukes C1 stage with poorly differentiated adenocarcinoma. No implantation was found in the trocar holes and the incisions of abdominal wall in the all patients. Conclusion Laparoscopic total mesorectal excision, with less surgical trauma, less postoperative pain and rapid recovery, is both feasible and safe, which should be performed by a skilled surgeon.