腹腔镜下经肛手套通路手术治疗直肠肿瘤临床分析

Clinical analysis of laparoscopic microsurgery by transanal glove port for excision of rectal tumor

目的探讨腹腔镜下经肛手套通路手术治疗直肠肿瘤的可行性及疗效。方法回顾性搜集我院2015年3月至2016年3月期间经评估适合行局部切除的直肠肿瘤患者17例,使用腹腔镜下经肛手套通路治疗。以手套联合切口保护套建立腹腔镜操作通路,使用腹腔镜作为照明设备,将超声刀、操作钳及镜头分别从3个指套伸入固定在手套上的鞘卡里。结果 17例患者的手术均获得成功,手术时间为35~90 min,平均54 min。制作密闭手套通路时间11~26 min,平均18 min。肿瘤直径1.4~3.5 cm,平均2.4 cm。术后病理结果:绒毛状腺瘤8例,高级别上皮内瘤变3例,低级别上皮内瘤变1例,类癌3例,腺癌2例。所有肿瘤组织标本切缘阴性。无感染、肠瘘、大出血等并发症。住院时间为4~9 d,平均5 d。门诊随访1–6个月,无一例失访,无远期并发症及复发。结论从本组有限的数据资料来看,腹腔镜下经肛手套通路手术治疗直肠肿瘤具有操作简单、安全有效的特点,为直肠肿瘤的个体化综合治疗提供了一种新选择。

Objective To explore feasibility and efficacy oflaparoscopic microsurgery by transanal glove port for excision of rectal tumor. Methods Seventeen patients with rectal tumor underwent laparoscopic microsurgery by transanal glove port for local excision of rectal tumor were chosen from March 2015 to March 2016. This device was constructed by using a incision protective sleeve and standard surgical glove. The laparoscopy was used as lighting equipment. The ultrasonic scalpel, operation forceps and lens were separately inserted into the fixed sheath card from the 3 finger gloves. Results The operations of 17 cases were completed successfully. The operative time was 35-90 min with an average 54 rain. The closed glove access time was 11 to 26 min with an average 18 min. The diameter of tumor was 1.4-3.5 cm with an average 2.4 cm. The results of postoperative pathology included 8 cases of villos adenemas, 3 cases of high-grade intraepithelial neoplasia, 1 case of low-grade intraepithelial neoplasia, 3 cases of carcinoid, and 2 cases of adenocarcinoma. All resection margins were negative. No infection, intestinal fistula, bleeding, and other complications were found. The hospital stay was 4-9 d with an average of 5 d. No recurrence was found during a follow-up of 1-6 months. Conclusions The preliminary results of limited cases in this study show that laparoscopic microsurgery by transanal glove port for excision of rectal tumor is easy, safe, and effective. It also provides a new choice for individualized comprhensive treatment of rectal tumor.