完全经肛门或联合腹腔镜的全直肠系膜切除术11例临床分析

Clinical analysis of 11 cases undergoing transanal minimal invasive or combined laparoscopy total mesorectal excision for rectal cancer

目的：探讨完全经肛门或联合腹腔镜的全直肠系膜切除术治疗直肠癌的可行性与安全性。方法回顾性收集2014年9月至2015年5月间于第三军医大学大坪医院行完全经肛门全直肠系膜切除术（taTME）或联合腹腔镜taTME的11例直肠癌患者临床资料。结果全组11例患者中3例顺利完成完全taTME手术，手术时间分别为210、230和215 min；8例采用腹腔镜联合taTME手术，手术时间150-290（中位数205） min。全组无中转开腹病例，但有2例患者因肿瘤偏大，而取下腹部约5 cm切口取出标本。全组患者术后第1天视觉模拟评分法（VAS）评分为1-3（2．0±0．6），术后排气时间6-70（30．2±17．3） h，术后住院时间4-12（7．5±2．5） d。全组患者发生术后皮下气肿1例，吻合口出血1例，排尿困难2例，均经保守治疗好转；1例术后第20天发现直肠阴道瘘行回肠造口术。随访期间，全组患者无肿瘤复发及死亡。结论对于合适的患者，taTME或联合腹腔镜taTME手术是安全可行的。

Objective To explore the feasibility and safety of transanal minimal invasive or combined laparoscopy total mesorectal excision. Methods Clinical data of 11 cases with rectal cancer undergoing transanal total mesorectal excision （taTME） in our hospital between September 2014 and May 2015 were analyzed retrospectively. Results Among 11 patients, 3 underwent pure-taTME successfully without abdominal incision and ileostomy, whose operation time was 210, 230, 215 min respectively, while other 8 patients underwent laparoscopy-assisted taTME （hybrid-taTME） with operation time ranging from 150 to 290 （median 205） min. No patient was transferred to open operation, while larger tumors of two patients were removed from hypogastric 5 cm incision. Postoperative first day V AS score was 1 to 3 （2.0±0.6）, the first flatus was 6 to 70 （30.2±17.3） h, hospital stay was 4 to 12 （7.5±2.5） d, the blood loss was （104±127） ml and the liquid food intake was （28.3±6.3） h. Postoperative complications included 1 case of subcutaneous emphysema, 1 case of anastomotic stoma bleeding, 2 cases of dysuria, which were cured by conservative therapy. One patient developed rectovaginal fistula 20 days after operation and then underwent ileostomy. No relapse of tumor or death during follow-up. Conclusions For suitable rectal cancer patients, taTME or hybrid-taTME is feasible.