腹腔镜个体化肛提肌外腹会阴联合切除术治疗低位直肠癌的临床体会(附55例报告)

Laparoscopic individualized extralevator abdominal perineal resection in the treatment of low rectal cancer:with a report of 55 cases

目的:探讨应用腹腔镜个体化肛提肌外腹会阴联合切除术治疗低位直肠癌的效果。方法:纳入2015~2016年收治的55例低位直肠癌患者作为研究对象,按照全直肠系膜游离原则离断肠系膜下血管,清扫253组淋巴结,继续向下分离至肛提肌裂孔,根据肿瘤位置进行个体化肛提肌外腹会阴联合切除术。结果:手术时间平均(234.9±56.5)min,术中出血量平均(49.8±37.3)mL,术后排气时间(3.1±1.0)d,尿管拔除时间(5.1±1.4)d,引流管拔除时间(8.0±2.4)d,淋巴结清扫数量(15.7±3.5)枚,平均住院(10.4±2.8)d。术中发生肠管穿孔2例,术后发生尿潴留6例,会阴切口感染4例,2例发生切口裂开,性功能障碍2例,术后出血2例,环周切缘阳性2例,1年内局部复发3例。结论:腹腔镜个体化肛提肌外腹会阴联合切除术治疗低位直肠癌在掌握适应证的前提下可获得较好的治疗效果。

Objective:To investigate the effect of laparoscopic individualized extralevator abdominal perineal excision in the treatment of low rectal cancer.Methods:A total of 55 patients with low rectal cancer were included from 2015 to 2016.According to the principle of total mesorectal excision,the rectum and inferior mesenteric vessels were separated,then the 253 lymph nodes were dissected.The tissue was separated down to the hiatus of levator ani muscle,and then the combined resection was performed according to the location of the tumor.Results:The average operative time was(234.9±56.5)min,the average intraoperative blood loss was(49.8±37.3)mL,the postoperative exhaust time was(3.1±1.0)d,the urinary catheter removal time was(5.1±1.4)d,and the drainage tube removal time was(8.0±2.4)d,the number of lymph nodes dissection was(15.7±3.5),the hospital stay was(10.4±2.8)d.Intestinal perforation occurred in 2 cases,urinary retention occurred in 6 cases,perineal incision infection occurred in 4 cases,incision rupture occurred in 2 cases,sexual dysfunction occurred in 2 cases,postoperative bleeding occurred in 2 cases,circumferential resection margin was positive in 2 cases.Local recurrence was found in 3 cases within one year.Conclusions:Laparoscopic individualized extralevator abdominal perineal excision can achieve good results in the treatment of low rectal cancer under the premise of mastering indications.