17例腹部无辅助切口标本经肛门拖出切除的腹腔镜直肠癌根治术疗效分析

Analysis of 17 cases underwent laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection

目的探讨经肛门拖出并切除手术标本的完全腹腔镜直肠癌根治术式的安全性、可行性和近期疗效。方法收集2014年5月1日至2016年3月31日在中国医学科学院肿瘤医院行经肛门拖出并切除手术标本的腹腔镜直肠癌手术患者的临床资料，回顾性分析该术式对患者术后恢复时间及并发症发生率等近期疗效的影响。结果共有17例患者行经肛门拖出并切除手术标本的腹腔镜直肠癌手术治疗，中位手术时间为105 min，中位术中出血量为35 ml，手术标本中位肿瘤近端肠管长度为16 cm，中位远端肠管长度为3.5 cm，中位清扫淋巴结数目为21枚，术后中位排气时间为43 h，术后中位住院时间为8 d，术后无出血、吻合口漏等严重并发症。结论在经选择的合适患者中，经肛门拖出并切除手术标本的腹腔镜直肠癌根治术是安全可行的，并具有满意的近期疗效。

ObjectiveTo study the feasibility, safety and short-term efficacy of total laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection.MethodsFrom May 2014 to March 2016, 17 patients with rectal carcinoma were treated by total laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection. The clinical data of these patients was collected and retrospectively analyzed to assess the impact of the operation on postoperative recovery time and the incidence of complications.ResultsAll operations had been successfully accomplished without conversion to open surgery or conversional laparoscopic-assisted surgery . The median operative time was 105 minutes. The median blood loss was 35 ml. The median proximal and distal margin of tumor is 16 cm and 3.5 cm. The median number of lymph nodes harvest is 21, and the median first bowl movement is 43 hours. The hospitalization after operation is 8 days. No patient underwent abdomen hemorrhage or anastomotic leakage.ConclusionLaparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection appears to be feasible, safe and with promising efficacy for selected patients.