经肛切除标本的直肠癌腔镜手术临床应用价值探讨

Preliminary application of transanal specimen extraction in laparoscopic rectectomy for middle rectal cancer

目的探讨腹部无辅助切口经肛切除标本的中位直肠癌腹腔镜手术的可行性及临床应用价值。方法回顾分析2013—06—01—2014—1008哈尔滨医科大学附属第二医院结直肠肿瘤外科，接受腹部无切口腹腔镜下经直肠拖出肛门外切除标本的直肠肿瘤根治术治疗的8例患者的临床资料，观察手术时间、术中出血量、淋巴结个数、术后恢复及并发症情况。结果8例患者手术均成功，其中男5例，女3例；年龄41～75岁，平均年龄（59．3±11．5）岁；体质量指数（22．1±2．3）kg／m2；肿瘤距离肛缘6～10cm，平均距离（7．75±1．49）cm。平均手术时间（187．75±29．77）min；平均术中出血量（34．88±9．13）mL；术后首次肛门排气时间为6～55h，平均排气时间（41．3±16．0）h。8例患者中TNM分期Ⅰ期3例，Ⅱ期5例；肿瘤直径2．0～4．5cm，平均直径（3．66±0．79）cm；清除淋巴结12～26枚，平均数目16．4枚，无阳性病例。术后患者疼痛轻微，疼痛程度评估表（visual analogue score，VAS）疼痛评分2．38±1．30，术后无功能障碍，无并发症发生。结论腹部无辅助切口经肛切除标本的中位直肠癌腹腔镜手术安全可行，值得推广应用。

OBJECTIVE To investigate the feasibility and efficacy of transanal specimen extraction in laparoscopic rectectomy for middle rectal cancer without abdominal incision. METHODS The clinic data of 8 patients who underwent transanal specimen extraction in laparoscopic rectectomy for middle rectal cancer without abdominal incision between June 1,2013 and October 8,2014 was analyzed respectively. Operation time, intraoperative blood loss, number of lymph nodes, complications and postoperative recovery were evaluated. RESULTS The laparoscopic rectectomy with transanal specimen extraction was successfully carried out in all of the eight patients,including 5 males and 3 females. The mean age of patients was （59.3±11.5） years old （range, 41-75 years old） and the body mass index was （22.1±2.3） kg/m2. The mean distance of the lower edge of the lesion from the anal verge was （7.75±1. 49） cm （range, 6-10 cm）. The mean op- eration time was （187.75±29.77） min and the estimated blood loss was （34.88±9.13） mL. The mean exsufflation time was （41.3±16.0） h （range, 6--55 h）. There were 3 patients diagnosed in stage Ⅰ and 5 patients in stage Ⅱ , according to TNM stage. The mean size of the lesion was （3.66±0.79） cm （range, 2.0-4.5 cm） ,and the mean number of lymph nodes harvested was 16.4（range, 12--26） without positive lymph nodes. The patients postoperatively complained minimal pain, and visual analogue score was 2.38± 1.30. There were no functional disorders associated with surgery or postoperative complications. CONCLUSION Transanal specimen extraction in laparoscopic rectectomy for middle rectal cancer without abdominal incision is a safe and effective procedure and it is worthy of application in clinic.