直肠拖出式吻合在腹腔镜低位直肠癌Dixon手术中的应用

Clinical application of pull-through proctectomy in laparoscopic Dixon surgery of low rectal cancer

目的：探讨直肠癌拖出式吻合在腹腔镜低位直肠癌Dixon手术中的应用价值。方法：回顾分析2010年6月至2014年6月行腹腔镜低位直肠癌根治术（Dixon术）并经肛门直肠拖出式吻合16例患者的临床资料,观察腹腔镜直肠癌拖出式吻合的手术效果。结果：16例均顺利完成保肛手术,无一例中转开腹。手术时间平均（175±55）min,术中出血量平均（80±45）ml;切除肿瘤长径0.8-4.0 cm,切除标本远端切缘距离瘤体≥2 cm,切缘阴性率100%,淋巴结转移0~9枚。TNM分期：Ⅰ期2例,ⅡA期1例,ⅢA期6例,ⅢB期3例,ⅢC期4例。术后胃肠功能恢复时间平均（35±7）h,尿管拔除时间平均（5±2）d,术后平均住院（10±3）d。无吻合口漏发生,发生前切除术后综合征3例。术后随访3-48个月,1例局部复发,1例肝转移。结论：直肠癌拖出式吻合在腹腔镜低位直肠癌Dixon术中可提高保肛率,改善患者术后生活质量,减少肿瘤的局部复发与种植转移。

Objective： To investigate the value of pull-through proctectomy in laparoscopic Dixon surgery of low rectal cancer.Methods： The clinical and postoperative follow-up data of 16 patients who underwent laparoscopic Dixon surgery and pull-through proctectomy during Jun. 2010 and Jun. 2014 were retrospectively reviewed,in order to observe the surgical effect of pull-through proctectomy in laparoscopic rectal surgery. Results： All the operations were performed successfully,without conversions to open surgery. The operative time was（ 175 ± 55） min,the intraoperative blood loss was（ 80 ± 45） ml,the resected tumor diameter ranged from 0. 8 to 4 cm,resected specimens distal margins to tumor was ≥2 cm,the margin-negative rate was 100%,the number of metastatic lymph node was 0-9. The TNM staging： 2 cases were stageⅠ; 1 case was stage ⅡA; 6 cases were stage ⅢA; 3 cases were stage ⅢB; 4 cases were stageⅢ C. The time for recovery of gastrointestinal function after surgery was（ 35 ± 7） h,the catheter removal time was（ 5 ± 2） d,the postoperative hospital stay was（ 10 ± 3） d. There was no anastomotic leakage,3 cases occurred anterior resection syndrome. In the follow-up of3-48 months,1 case had local recurrence,1 case suffered from liver metastasis. Conclusions： Pull-through proctectomy in laparoscopic Dixon surgery of low rectal cancer can increase the sphincter preservation rate,improve the life quality of patients after surgery and reduce local recurrence and metastasis.