腹腔镜下全直肠系膜切除联合括约肌切除术治疗超低位直肠癌的临床研究

Clinical research of laparoscopic total mesorectum excision with sphincter resection for low rectal cancer

目的探讨腹腔镜全直肠系膜切除联合内括约肌切除术治疗超低位直肠癌的安全可行性,并评价肿瘤根治效果及术后肛门功能。方法回顾性分析该院2009年-2013年35例超低位直肠癌患者采用腹腔镜全直肠系膜切除联合内括约肌切除术的临床资料。结果所有患者手术切缘均阴性,远切缘距肿瘤下缘距离平均2.3（2.0-2.5）cm。术中出血平均150（50-300）m L,手术时间平均4.5（3-6）h。术后持续胃肠减压4-72 h,肠蠕动恢复时间（23±18）h,术后1-3 d开始进食,1-4 d拔除导尿管下床活动,平均住院7 d。术后随访8-29周,术后3个月内大便次数3-11次/d,术后1年大便次数1-3次/d。2例出现吻合口瘘。目前未发现转移及复发病例。结论采取腹腔镜全直肠系膜切除联合内括约肌切除术是治疗超低位直肠癌和保留肛门的可行途径,患者创伤小,出血少,疼痛轻,康复快,其肛门功能及治疗效果均满意。

[ Objective ] To study the laparoscopic total mesorectum excision combined internal sphincter resection for safety feasibility of ultra low position rectal cancer, and evaluate efficacy of cancer treatment and postoperative anal function. [ Methods ] The clinical data of 35 patients with ultra low position rectal cancer with laparoscopic total mesorectum excision combined internal sphincter resection were retrospectively analyzed from 2009 to 2013. [Results] The surgery cut edge for all patients was negative, far cut edge distance from the edge of the tumor was average 2.3 cm （2.0-2.5 cm）. Intraoperative bleeding in 150 mL （50~300 mL）, average operation time was 4.5 h （3- 6 h）. Continuous gastrointestinal decompression after 4-72 h, intestinal peristalsis recovery time was （23±18） h, postoperative 1-3 d patients began to eat, 1 ~4 d bed urethral catheter, the average hospitalization 7 d. Followed up for 8-29 weeks postoperatively, within 3 months after defecate number 3-11 times/d, 1 years after defecate number 1-3/d. 2 cases of anastomotic fistula. No metastasis and recurrence was found up to now. [ Conclusion ] Laparoscopic total mesorectum excision combined internal sphincter resection is a feasible way for the treatment of low position rectal cancer and preserving anus with small trauma, less bleeding, light pain, quicker recovery, the anal function and treatment effects are quite satisfactory.