54例腹腔镜直肠癌经腹超低位吻合治疗分析

Laparoscopic transabdominal ultra-low anastomosis for rectal cancer: experience of 54 cases

目的:探讨腹腔镜直肠癌经腹手术超低位吻合保肛的安全性和可行性。方法:回顾性分析2014年7月至2017年6月西南医科大学附属医院收治的54例行腹腔镜直肠癌根治、超低位吻合患者的临床资料,观察并分析术后疗效。结果:所有患者顺利完成手术,无中转开腹及手术死亡病例。平均手术时间(165±31)min,术中出血(12±5)mL。本组患者未常规进行预防性造瘘。术后发生吻合口出血2例(3.7%),吻合口漏3例(5.6%),均经保守治疗痊愈。术后患者排尿功能、性功能保持良好,术后一年时绝大部分患者肛门控制排便功能满意,术后随访两年以上均无局部复发,也无死亡病例,但手术一年后有3例患者出现肝脏转移。结论:腹腔镜直肠癌经腹超低位吻合近期效果良好,远期效果有待进一步观察。

Objectives: To evaluate the safety and feasibility of ultra-low anastomosis for anal preservation in laparoscopic rectal cancer surgery. Methods: The clinical data of 54 patients with low rectal cancer admitted to The Affiliated Hospital of Southwest Medical University from July 2014 to June 2017 were retrospectively analyzed. The short-term effect and complications were analyzed. Results:All patients underwent successful operations;conversion to laparotomy or death was not observed in any of the patients. The mean operative time was(165 ± 31) minutes, and the intraoperative bleeding volume was(12 ± 5) mL. There was no prophylactic ileostomy in all patients. Postoperative anastomotic bleeding and anastomotic leakage occurred in 2 and 3 cases, respectively;these complications were managed with conservative treatment. Postoperative urination and sexual functions of the patients remained good, and most patients were satisfied with their anal function 1 year post-operation. No local recurrences or deaths were noted after follow-up for more than 2 years. However, liver metastases were detected in 3 patients 1 year post-surgery. Conclusions: Laparoscopic transabdominal ultra-low anastomosis for rectal cancer has a good short-term effect;however, the long-term effect remains to be evaluated.