腹腔镜辅助经肛门中低位直肠癌全直肠系膜切除术治疗体会

Experience of transanal total mesorectal excision with laparoscopic assisted for min-low rectal cancer

目的探讨腹腔镜辅助经肛门中低位直肠癌全直肠系膜切除术的优势与其不足。方法回顾性分析北京协和医院基本外科2014年11月—2018年5月施行腹腔镜辅助的经肛门直肠癌全直肠系膜切除术的38例中低位直肠癌患者临床资料。主要观察指标为性别、体重指数、手术时间、术中出血量、围手术期并发症发生率、肿瘤距下切缘的距离、切除标本直肠系膜的完整性和淋巴结获取的数量，以及术后平均住院时间。结果38例患者手术均无中转开腹，其中男性26例（68．4％），女性12例（31．6％），体重指数〉24kg／m。有25例，手术时间（175．2±37．6）min，术中出血（63．9±42．7）ml，术中并发骶前静脉出血1例（2．6％），术后发生吻合口漏6例（15．8％）。共18例患者出现围手术期并发症，发病率为47．4％。标本远切端距肿瘤下缘（2．1±0．4）em，切除标本直肠系膜完整34例（89．5％）。获得淋巴结（14．2±4．5）枚。术后住院时间为（9．8±5．9）d。结论腹腔镜辅助的经肛门中低位直肠癌全直肠系膜切除术可以更加准确保证足够的远切缘以及直肠系膜完整性。

Objective To investigate the advantages and disadvantages of transanal total mesorectal excision with laparoscopic assisted for min-low rectal cancer. Methods Retrospectively analyzed the clinical data of 38 patients with min-low rectal cancer who undernent laparoscopically assisted transanal total anorectal rectal cancer from November 2014 to May 2018 in the Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.The main outcome measures included gender, BMI, the operating time, intra-operative blood loss, the intra- and post-operative complication rate, the distal resection margin length and the circumferential resection margin status of the pathological specimen, the number of lymph nodes acquisitions, as well as the postoperative average hospitalization time. Results The surgery＂ was completed smoothly for all patients in this studying, with no conversion to open surgery. Among all the 38 patients, there were 26 （68.4%） male cases and 12（31.6% ） female cases, and 25 cases were with a body mass index （BMI） over 24 kg/m2. The average operating time was （ 175. 2 ± 37.6） minutes. The average intra-operative blood loss was （63.9 ± 42.7） ml. The complications included 1 case of intra-operative presacral venous hemorrhage, and 6 cases of post-operative anastomotie leak （ 15. 8% ）. There were 18 cases happened perioperative complications, and the rate was 47.4%. The average distance from the distal resection margin to the lower end of the tumor was （2.1 ± 0.4） em. There were 34 eases of complete mesorectal excision. Tile average number of lymph nodes retrieved was 14.2 ± 4.5. The average postoperative hospital stay was （9.8 ± 5.9） days. Conclusion Transanal total mesorectal excisionwithlaparoscopic-assisted formid-lowreetal cancer can more accurately ensure adequate distal marzin and mesoreetal integrity.