taTME在低位及超低位直肠癌术中的应用

Application of taTME in low and ultra-low rectal cancer surgery

目的:探讨经肛直肠全系膜切除术(transanal total mesorectal excision,taTME)治疗低位及超低位直肠癌的临床效果和安全性。方法:回顾性分析行taTME治疗的7例低位及超低位直肠癌患者的临床资料,评价治疗的可行性、安全性和疗效。结果:7例患者均顺利完成腹腔镜辅助taTME,无中转开腹,3例用管型吻合器行结-直肠端端吻合,经腹经肛门同时手术6例,序贯进行1例,手术时间平均(205.7±104.8)min,术中出血量平均(35.7±31.1)mL;保肛率100%(7/7);3例患者行预防性回肠造口,均于术后3个月行回肠还纳。拔除骶前引流管时间(5.4±3.0)d,术后(9.6±2.4)d出院;吻合口漏2例,无死亡、吻合口狭窄、肠梗阻、切口感染等并发症发生。淋巴结检出数平均为(10.4±2.8)枚,阳性淋巴结(0.7±1.7)枚。结论:taTME技术治疗低位及超低位直肠癌安全可靠。

Objective:To investigate the clinical efficacy and safety of transanal total mesorectal excision(taTME)in the treatment of low and ultra-low rectal cancer.Methods:The clinical data of 7 patients with low and ultra-low rectal cancer treated with TATME were retrospectively analyzed to evaluate the feasibility,safety and efficacy of the treatment.Results:All 7 patients successfully completed laparoscopic assisted taTME,without conversion to laparotomy.3 patients underwent end-to-end colorectal anastomosis with a tube stapler,6 patients underwent simultaneous abdominal and anal surgery,and 1 patient underwent sequential operation.The average operative time was(205.7±104.8)min,and the average intraoperative blood loss was(35.7±31.1)mL.Anus preservation rate was 100%(7/7);Three patients underwent a prophylactic ileostomy,and ileal remission was performed 3 months after the operation.The time of removing the anterior sacral drainage tube was(5.4±3.0)d,and the hospital was discharged(9.6±2.4)d after surgery.There were 2 cases of anastomotic leakage,no death,anastomotic stenosis,intestinal obstruction,incision infection and other complications.The average number of lymph nodes detected was(10.4±2.8)and(0.7±1.7)positive lymph nodes.Conclusion:TATME technique is safe and reliable in the treatment of low and ultra-low rectal cancer.