腹腔镜下经肛微创手术治疗直肠肿瘤的疗效分析

New method of minimally invasive treatment for rectal cancer-transanal laparoscopic microsurgery

目的 探讨腹腔镜器下完成经肛微创手术治疗直肠肿瘤的可行性及疗效.方法 我院2012年6月至12月14例适合于局部切除的直肠良性肿瘤、类癌病例选择腹腔镜下经肛微创治疗.手术方法以肛管扩张器、手套联合切口保护套建立腹腔镜操作通路,使用腹腔镜/结肠镜作为照明和充气设备,超声刀完成直肠黏膜下切除或全层切除,全层切除创面采用可吸收线缝合.结果 14例患者手术过程顺利,无围手术期并发症.手术时间30 ～ 70 min,其中建立操作入路平均花费15 min.切除的肿瘤直径1.5 ～3.8cm,大体观和病理检查证实均为R0切除.随访6～12个月无复发及远期并发症.结论 使用腹腔镜器械设备完成经肛微创手术治疗直肠肿瘤安全有效,但该术式部分操作细节仍需改进.

Obejective To evaluate the feasibility and efficacy of transanal microsurgery for rectal tumor resection with laparoscopic instruments. Methods Consecutive 14 patients eligible for TEM over a 6-month period were offered a procedure of simplified transanal endoscopic microsurgery. This operative access device was constructed ontable using a circular anal dilator, incision protective sleeve and standard surgical glove, along with standard, straight laparoscopic trocar sleeves. Laparoscopic or eolonscopic instruments were used for light and aera- tion. Ultrasound scalpel was used to completely resect rectal mucosa or full-thickness rectal wall. The wounds from full-thickness rectal wall resection were sutured. Results The surgery of 14 cases went successfully and smoothly with the range （ 30 ~ 70） min. All patients recovered well without intraoperative and minimal postoperative morbidity. The diameter of resected tumors was 1.5 ～3.5 cm and the general appearance together with pathological examination confirmed R0 resection of rectal tumors. After a follow - up of 6 - 12 months, no recurrence was found. Conclusion Transanal endoscopic microsurgery with laparoscopic instruments is a safe, effective and readily available access tool for the treatment of rectal tumors. However this method still deserves improvement.