经阴道取标本的腹腔镜乙状结肠或直肠联合子宫＋双侧附件切除治疗局部进展期结直肠癌

Transvaginal extraction of the specimen in laparoscopic sigmoidectomy or protectomy combined with total hysterectomy and bilateral adnexectomy for local advanced colorectal cancer

目的探讨和总结经阴道取出标本的腹腔镜乙状结肠或直肠联合全宫+双侧附件切除治疗局部进展期结直肠癌的可行性、安全性、手术技巧,以及近期和远期效果。方法 2000年1月~2014年12月,对36例乙状结肠或直肠癌侵犯子宫卵巢患者施行腹腔镜下乙状结肠或直肠联合全宫+双侧附件切除,标本经阴道取出。结果全组无中转开腹,无手术死亡。平均手术时间(173±13)min,平均出血量(80±12)mL。所有病人术后均无使用止痛药物,平均VAS疼痛评分:2.9±1.0,术后第一天均可下床活动。平均肛门排气时间(82±18)h,平均术后住院时间(6.9±1.8)d。术后并发症发生率31%(11/36),其中单纯吻合口瘘1例,单纯阴道瘘1例,直肠阴道瘘2例,术后早期炎性肠梗阻3例,尿潴留2例,肺部感染2例。中位随访时间53(14~128)个月。中位生存期限63.95个月。1年生存率100%,3年生存率83%,5年生存率61%。结论经阴道取出标本的腹腔镜下乙状结肠或直肠联合全宫+双侧附件切除治疗局部进展期结直肠癌在技术上是可行的,安全性是良好的。不仅具有创伤小、恢复快等优势,远期随访亦取得满意的肿瘤学治疗效果。

Objective To investigate the safety and feasibility of transvaginal extraction of the specimen in laparoscopic sigmoidectomy or protectomy combined with total hysterectomy and bilateral adnexectomy for eolorectal cancer. Methods From January 2000 to December 2014, 36 cases of sigmoid colon or rectal cancer were undergone laparoscopic sigmoidectomy or protectomy combined with total hysterectomy and bilateral adnexectomy in which the specimen were extracted by vagina. Results No patients needed open conversion. Mean operative time was （173＋ 13） min. Mean amount of blood loss was （80_＋ 12） ml. No patients needed painkillers post operation. The mean VAS score was （2.9_＋ 1.0）. Mean time of anal flatus was （ 82＋ 18 ） h. Mean time of postoperative hospital stay was （6.9-＋ 1.8 ） d. The rate of complication was 31% （11/36） , including anastomotic fistula in one case, vaginal stump fistula in one case, rectalvaginal fistula in two cases, early postoperative inflammatory intestinal obstruction in 3 cases, urinary retention in 2 cases, pulmonary infection in 2 cases. The median time of follow-up was 53 months （14 - 128 m）. The median survival time was 63.95 months. One-year survival rate was 100%, three-year survival rate was 83% and five-year survival rate was 61%. Conclusion Transvaginal extraction of the specimen in laparoscopic sigmoidectomy or proteetomy combined with total hysterectomy and bilateral adnexectomy for local advanced colorectal cancer is feasible and safe in surgical procedure. It had not only such advantages as little trauma, quick recovery, but also satisfactory therapeutic effect of oncology in long-term follow-up.