腔镜辅助下经肛门手术治疗直肠肿瘤24例

Laparoscopy Assisted Trans-anal Surgery for Rectal Tumor:24 Cases Report

目的探讨腔镜辅助下经肛门手术治疗早期直肠癌和直肠腺瘤的可行性和安全性。方法回顾性分析2015年2月~2017年2月腹腔镜辅助下经肛门直肠肿瘤切除术24例患者的临床资料。肿瘤距齿状线平均(6.2±2.5)cm,肿瘤直径(1.5±0.9)cm。结果本组24例均成功完成腔镜辅助下经肛门直肠肿瘤切除术,其中直肠腺瘤12例,直肠高级别上皮内瘤变6例,直肠癌6例(包括T0期4例,T1期1例,T2期1例)。术中出血(20.5±8.8)ml,手术时间(35.2±15.5)min,术后住院3~9 d。1例T1期侵及黏膜下层外1/3,再次入院行腹腔镜下直肠癌前切除术。1例T2期侵及黏膜肌层,拒绝再次手术后失访。23例平均随访(18±6)个月,均未发现肿瘤复发或转移。结论腔镜辅助下经肛门手术治疗直肠肿瘤操作简单,手术难度小,在合理选择适应证的前提下可以获得良好的治疗效果。

Objective To discuss the feasibility and safety of laparoscopy assisted trans-anal surgery for rectal tumor. Methods The clinical data of 24 cases performed laparoscopy assisted trans-anal tumor resection from February 2015 to February 2017 were reviewed. The distance between tumor to anocutaneous line was（ 6. 2 ± 2. 5） cm,and the diameter of tumor was（ 1. 5 ± 0. 9） cm. Results All 24 patients were accomplished the surgery successfully,including 12 cases of rectal adenoma,6 cases of high grade intraepithelial neoplasia and 6 cases of rectal cancer（ 4 of T0,1 of T1 and 1 of T2）. The mean operation time was（ 35. 2 ±15. 5） min,mean blood loss was（ 20. 5 ±8. 8） ml,and the postoperative hospital stays was 3 to 9 days.One case of T1 invaded submucosa 1/3 was carried out reoperation of laparoscopic colorectal cancer resection,1 case of T2 invaded mucosal muscularis gave up the reoperation and lost to follow-up after surgery. 23 cases were followed up for（ 18 ± 6） months. No tumor recurrence and metastasis was found. Conclusions Laparoscopy assisted trans-anal surgery is simple for treatment of rectal tumor. On the premise of reasonable selection of indication,it can achieve an ideal therapeutic effect.