双入路法在腹腔镜下游离结肠脾曲的直肠癌保肛术中的应用

Application of double-entry approach in laparoscopic lower rectal sphincter preservation for rectal cancer with splenic flexure

目的总结腹腔镜双入路法在游离脾曲的直肠癌保肛术的操作经验及应用价值。方法回顾分析2016年4月至2017年9月由同一组手术医师完成的双入路法腹腔镜下游离结肠脾曲的直肠癌保肛手术38例患者的临床资料及短期随访结果。结果所有手术均获成功,无中转开腹病例,术中无左侧输尿管、左肾、脾脏及胰腺损伤。手术时间为142.4±35.3 min,术中出血量98.7±34.5 ml,切除标本长度为21.1±6.7 cm,肿瘤距下切缘4.5±2.8 cm,清除淋巴结为12.7±6.3枚,术后排气时间3.6±1.7 d,住院时间12.4±3.2 d。术后并发症4例(10.5%),其中切口感染2例(5.26%),尿潴留1例(2.63%),肺部感染1例(2.63%),无吻合口漏、吻合口出血等并发症发生。全组患者随访至今,均未见肿瘤复发。结论双入路法在腹腔镜下游离结肠脾曲的直肠癌保肛术中径路准确,解剖层面清晰、易于掌握,值得推广应用。

Objective To summarize the experience and value of laparoscopic double-entry in sphincter preserving surgery for rectal cancer with free splenic flexure.Methods The clinical data and short-term follow-up results of 38 patients who underwent anal sphincter preservation of the rectum with laparoscopic surgery of the colon by double-entry laparoscopy performed by the same group of surgeons from April 2016 to September 2017 were analyzed retrospectively.Results All the operations were successful and none of the patients were converted to open surgery.There was no left ureter,left kidney,spleen and pancreas injury in the operation.The mean operation time was 142.4±35.3 min,mean blood loss 98.7±34.5 ml,mean specimens 21.1±6.7 cm,mean tumor resection margin 4.5±2.8 cm.The mean number of lymph nodes harvested was 12.7±6.3,mean postoperative exhaust time 3.6±1.7 day,and the mean hospitalization time was 12.4±3.2 day.There were four(10.5%)postoperative complications including two(5.26%)incision infection,one(2.63%)urinary retention and one(2.63%)pulmonary infection.No complications such as anastomotic leakage and anastomotic bleeding occurred.All patients were followed up so far,no tumor recurrence.Conclusion The double-entry approach is accurate,anatomical and easy to master in laparoscopic anus preservation for rectal cancer with splenic flexure.It is worthy of popularization and application.