双隧道分离技术在腹腔镜直肠癌根治术中的应用

Double Tunnel Separation Technique in Laparoscopic Radical Resection for Rectal Carcinoma

目的探讨双隧道分离技术在腹腔镜直肠癌根治术中的应用价值。方法回顾性分析2010年9月-2014年7月67例腹腔镜直肠癌根治术的临床资料。采用乙状结肠系膜下隧道分离技术及直肠系膜下隧道分离技术,行腹会阴联合切除术（Miles术）37例,经腹前切除术（Dixon术）30例。结果 67例手术均获成功。手术时间100-240 min,平均158min。术中出血量50-200 ml,平均110 ml。住院时间8-15 d,平均10 d。术后吻合口漏1例,小肠盆底粘连致机械性肠梗阻1例,下肢深静脉血栓形成1例,均保守治愈。结论双隧道分离技术在腹腔镜直肠癌根治术中能真正做到直肠全系膜切除（total mesorectal excision,TME）,从而有效保护血管、神经、输尿管,最大程度清扫淋巴结、系膜内淋巴结外肿瘤种植结节（extranodal tumor deposit,ENTD）。

Objective To discuss the value of double tunnel separation technique in the application of laparoscopic radical resection for rectal carcinoma. Methods A retrospective analysis of clinical data of 67 cases of laparoscopic radical resection for rectal carcinoma from September 2010 to July 2014 was made. There were 37 cases of Miles operation and 30 cases of Dixon operation,with laparoscopic double tunnel separation technique which refered to under the sigmoid colon mesentery space and under the mesorectum space. Results All cases of laparoscopic radical resection were completed. The duration of operation was 100- 240 min,with an average of 158 min. The intraoperative blood loss was 50- 200 ml,with an average of 110 ml. The hospitalization time was 8- 15 d,with an average of 10 d. Complications included postoperative anastomotic leakage in 1 case,small intestinal obstruction induced by intestine pelvic adhesion in 1 case,and lower extremity deep venous thrombosis in 1 case,all of which were cured with conservative treatment. Conclusions Double tunnel separation technique in laparoscopic radical resection is helpful to application of total mesorectal excision,thus effectively protects blood vessels,nerves,and ureters. Meanwhile,the lymph nodes and extranodal tumor deposits can be cleaned to the greatest degree.