腹腔镜肛提肌切除的腹会阴联合切除术安全性及近期疗效评估(附40例报告)

Feasibility and short-term outcome of laparoscopic-assisted abdominoperineal excision with transabdominal levator ani transection:a report of 40 cases

目的:探讨低位直肠癌行腹腔镜肛提肌切除的腹会阴联合切除术(APE)的安全性,评估其近期疗效。方法:回顾分析2014年10月至2016年3月间40例低位直肠癌行腹腔镜肛提肌切除的APE手术病人的临床资料,研究其手术安全性、恢复情况、并发症、环周切缘及近期疗效。结果:本研究手术时间(138.9±37.6)min,术中出血量(92.2±35.1)m L,术中淋巴结清扫数目(11.9±3.4)枚。无中转开腹,无死亡病例。术中见穿孔1例。术后病理见环周切缘阳性1例。术后造口首次排气时间、恢复流质饮食时间、拔除导尿管时间、住院时间分别为(2.0±1.0)d、(3.1±0.7)d、(9.6±2.1)d、(14.9±1.8)d。术后见会阴切口感染2例,泌尿功能障碍3例,性功能障碍1例。结论:腹腔镜肛提肌切除的APE安全、可行且符合肿瘤根治原则,近期疗效满意。

Objective To explore the feasibility, safety and short-term outcome of laparoscopic-assisted abdominoperineal excision with transabdominal levator ani transection for lower rectal cancer. Methods Clinical data of 40 patients with lower rectal cancer undergoing the operation from October 2014 to March 2016 were studied retrospectively. The safety of operation, recovery, complication, circumferential resection margin（CRM） and short-term outcome were analyzed.Results The average operation time was（138.9 ±37.6） min with blood loss（92.2 ±35.1） m L. The total number of lymph nodes（11.9±3.4） was removed. No case was converted to open surgery without mortality. CRM was positive in 1 case with perforation in 1 case. The times to first exhaust, resume diet liquid, remove urethral catherter and hospital stay were（2.0 ±1.0） d,（3.1±0.7） d,（9.6±2.1） d and（14.9±1.8） d respectively. Perineal wound infection was found in 2 cases. Three cases had postoperative urinary dysfunction and 1 case with sexual dysfunction. Conclusions The operation could be safe, radical and favorable short-term outcome.