腹腔镜辅助经肛全直肠系膜切除术治疗中低位直肠癌的临床分析（附32例报告）

Clinical analysis of laparoscopic-assisted transanal total mesorectal excision for middle-low rectal carcinoma(32 cases)

目的探讨腹腔镜辅助经肛全直肠系膜切除术(TaTME)治疗中低位直肠癌的安全性和有效性,并分享手术经验。方法回顾性分析南华大学附属第一医院胃肠外科2017年12月-2018年12月行腹腔镜辅助TaTME的32例中低位直肠癌患者的临床资料。结果32例患者均顺利完成手术,无中转开腹者;手术时间为(257.50±32.60)min,术中出血量为(76.56±15.64)ml;TME标本质量优良者(评价为3级/2级)占96.88%,环周切缘阴性率为96.88%,远切缘阴性率为100.00%;术后排气时间为(1.69±0.54)d,首次下床活动时间为(1.34±0.28)d,引流管拔除时间为(7.63±3.26)d,术后住院天数为(12.87±1.56)d;术后无严重并发症(Clavien-DindoⅢ~Ⅳ级)发生;中位随访11.5个月,未见肿瘤复发转移。结论①对于中低位直肠癌患者,腹腔镜辅助TaTME是安全可行的,近期疗效较好;②应严格把握TaTME的适应证,并在掌握技术要点的基础上谨慎开展。

Objective To explore the safety,feasibility,short-term outcomes and share operation experiences of laparoscopic-assisted transanal total mesorectal excision(La-TaTME)for middle-low rectal cancer.Methods This retrospective research collected and analyzed the clinical data of 32 patients diagnosed with middle or low rectal carcinoma who underwent La-TaTME from December 2017 to December 2018.Sequential La-TaTME was applied to patients by the same operation team.Results All the 32 patients successfully underwent La-TaTME and no case was converted to laparotomy.The average operative time was(257.50±32.60)min and average blood loss during operations was(76.56±15.64)ml.The TME specimens with good quality(grade 3/grade 2)accounted for 96.88%;the negative rate of circumferential resection margin was 96.88%;the negative rate of distal resection margin was 100.00%.The postoperative first exhaust time and first ambulation time were at(1.69±0.54)day and(1.34±0.28)day,respectively.Drainage tubes were removed after(7.63±3.26)days,with postoperative hospital stay being(12.87±1.56)days.No serious complications(Clavien-DindoⅢ~Ⅳ)occurred within 30 days after surgery.During the follow-up period with median follow-up 11.5 months,no local recurrence or metastasis was observed and there was no death.Conclusion La-TaTME is a safe and feasible alternative to standard laparoscopic TME for middle or low rectal cancer when operated by an experienced colorectal surgeon and the short-term outcomes of La-TaTME are well enough.However,the indications of TaTME should be strictly abide by and this novel surgical procedure must be carried out cautiously on the basis of mastering the technically essential points.