腹腔镜全盆腔脏器切除术治疗局部晚期及复发性直肠癌的临床效果分析

Analysis of the clinical efficacy of laparoscopic total pelvic exenteration in the treatment of locally advanced and recurrent rectal cancer

目的:探讨腹腔镜下直肠癌全盆腔脏器切除术治疗局部晚期及复发性直肠癌的可行性及短期疗效。方法:回顾分析2020年7月7日至2020年11月13日采用腹腔镜下直肠癌全盆腔脏器切除术治疗的5例局部晚期及复发性直肠癌患者的临床资料。5例患者中男4例,女1例;年龄66(60-71)岁,BMI 20.3(16.4-24.2)kg/m2。4例患者进行新辅助放化疗。结果:5例患者均顺利完成腹腔镜下直肠癌全盆腔脏器切除术,无中转开腹,均达到R0切除。术中出血量1010(350-2000)mL,手术时间507(360-655)min。术后住院13.2(10-18)d。术后发生1例尿路感染,术后30 d内无死亡,无再次手术。结论:腹腔镜下直肠癌全盆腔脏器切除术可使潜在R0切除的局部晚期及复发性直肠癌患者症状缓解;但手术创伤大,术中出血较多,手术难度较大,需仔细进行术前评估,谨慎选择局部晚期及复发性直肠癌患者。

Objective:To investigate the feasibility and short-term efficacy of laparoscopic total pelvic exenteration(L-TPE)in the treatment of locally advanced and recurrent rectal cancer.Methods:The clinical data of 5 patients with locally advanced and recurrent rectal cancer treated with L-TPE from Jul.7,2020 to Nov.13,2020 were retrospectively analyzed.Among the 5 patients,4 were male and 1 was female;the age was 66 years old(60-71 years old),and the BMI was 20.3 kg/m2(16.4-24.2 kg/m2);four patients received neoadjuvant chemoradiotherapy.Results:All patients underwent L-TPE and permanent sigmoid colostomy without conversion to open surgery,and all cases achieved R0 resection.The intraoperative blood loss was 1010 mL(350-2000 mL),and the operation time was 507 min(360-655 min).The postoperative hospital stay was 13.2 d(10-18 d).One case of urinary tract infection occurred after the operation.There was no death or reoperation within 30 d after operation.Conclusions:L-TPE can relieve symptoms of locally advanced and recurrent rectal cancer patients with potential R0 resection,but the operation is traumatic,bleeding is more,and the operation is difficult,so careful preoperative evaluation and careful selection of patients with locally advanced and recurrent rectal cancer are needed.