腹腔镜辅助经肛全直肠系膜切除术在低位直肠癌根治术中的临床应用

Clinical application of laparoscopy-assisted transanal total mesorectal excision in radical resection of low rectal cancer

目的:探讨腹腔镜辅助经肛全直肠系膜切除术在低位直肠癌根治术中的应用价值。方法:回顾分析2016年10月至2017年12月为21例低位直肠癌患者行腹腔镜辅助经肛全直肠系膜切除术的临床资料及治疗效果。结果:21例手术均顺利完成,术中出血量60～120 mL,手术时间110～180 min;切除标本远端切缘≥2 cm,环周切缘阴性;术后发生1例吻合口漏、1例肺部感染。病理类型:低分化腺癌3例,中分化腺癌8例,高分化腺癌10例。TNM分期Ⅰ期4例,Ⅱ期9例,Ⅲ期8例。术后8～12 d出院。结论:腹腔镜辅助经肛全直肠系膜切除术治疗低位直肠癌安全、可行,无腹部辅助切口,具有微创、术后康复快、住院费用低等优势,值得推广应用。

Objective:To explore the clinical value of laparoscopy-assisted transanal total mesorectal excision in radical resection of low rectal cancer.Methods:The clinical data and therapeutic effect of 21 patients with low rectal cancer treated with laparoscopyassisted transanal total mesorectal excision from Oct.2016 to Dec.2017 were retrospectively analyzed.Results:All of the surgeries were successfully completed.Intraoperative bleeding was 60-120 mL,operation time was 110-180 min.Distal margin was≥2 cm,circumferential margin was negative.There was 1 case of postoperative anastomotic leakage and 1 case of pulmonary infection.Pathological type included 3 cases of poorly differentiated adenocarcinoma,8 cases of moderately differentiated adenocarcinoma,and 10 cases of highly differentiated adenocarcinoma.TNM staging included 4 cases of stageⅠ,9 cases of stageⅡand 8 cases of stageⅢ.All of the patients were discharged from hospital after operation 8-12 d later.Conclusions:Laparoscopic-assisted transanal total mesorectal excision surgery for low rectal cancer is safe and feasible without abdominal assistant incision.This procedure has advantages of minimal invasion,quick postoperative recovery and few hospitalization costs,it is suitable for popularization and application.