腹腔镜经腹会阴联合手术治疗低位直肠癌的临床体会

Clinical application of laparoscopic Miles surgery for low rectal cancer

目的:探讨腹腔镜经腹会阴联合手术治疗低位直肠癌的临床疗效及操作体会。方法:回顾分析为31例低位直肠癌患者行腹腔镜经腹会阴联合手术的临床资料,手术均采用五孔法,操作过程中遵循"以神经为核心,沿间隙解剖"及恶性肿瘤的根治原则。结果:31例均顺利完成腹腔镜手术,术中出血量平均(48.77±17.87)ml,手术时间平均(189.84±43.26)min,术后胃肠功能恢复时间平均(49.29±12.54)h,术后平均住院(8.55±1.12)d,清扫淋巴结总数平均(22.58±5.33)枚。均无血管、输尿管损伤发生,患者康复出院,无排尿及性功能障碍。结论:掌握淋巴结的清扫、输尿管及神经的保护,注意盆底创面的浆膜化,注重术后功能的恢复等相关手术细节,腹腔镜经腹会阴联合手术治疗低位直肠癌是安全、可靠的。术中应遵循"以神经为核心,沿间隙解剖"及恶性肿瘤的根治原则,注重外科层面的游离、血管切断、神经输尿管的保护及造口的处理等。

Objective：To evaluate the effect and clinical application of laparoscopic Miles operation for low rectal cancer.Methods：The clinical data of 31 patients who underwent laparoscopic Miles operation for low rectal cancer were retrospectively analyzed. Five-hole method was used in all surgical procedures,and principles in anatomy of＂nervous as the core,along the clearance＂and radical excision of malignant tumor were followed. Results：Laparoscopic radical surgery were completed successfully in 31 patients. The mean intraoperative blood loss was（48. 77 ± 17. 87） ml,the mean operation time was（189. 84 ± 43. 26） min,the mean time for gastrointestinal function recovery was（49. 29 ± 12. 54） h after operation,the mean time of postoperative hospital stay was（8. 55 ±1. 12） d,and the mean number of harvested lymph nodes was（22. 58 ± 5. 33）. No complications such as injury of blood vessel or ureter,and no urination and sexual dysfunction occurred. Conclusions：By mastering the lymphadenectomy and protection of ureter and nerves,and focusing on principles of serosa for wound and details related to postoperative function recovery,laparoscopic Miles operation for low rectal cancer is safe and reliable. Principles in anatomy of＂nervous as the core,along the clearance＂and radical excision of malignant tumor should be followed during the procedure. Separation on surgical lay,dissection of blood vessels,protection of ureter and nerves,and treatment of stoma should be paid attention to.