保留左结肠动脉腹腔镜低位直肠癌经括约肌间切除术初探

Preliminary exploration of laparoscopic intersphincteric resection for lowrectal cancer with left colonic artery preserved

目的:初步探讨保留左结肠动脉的腹腔镜低位直肠癌括约肌间切除术的可行性及安全性。方法:回顾分析2019年12月至2021年12月为13例低位及超低位直肠癌患者行腹腔镜辅助保留左结肠动脉的括约肌间切除术的临床资料。手术均由同一组医师采用五孔法完成。结果:手术均顺利完成,手术时间平均(210.3±82.6)min,术中出血量平均(33.6±18.7)mL,保肛率100%(13/13)。总体并发症发生率15.4%(2/13),其中吻合口漏1例(A级漏),吻合口膜状狭窄1例。淋巴结清扫数量(16.6±3.7)枚,术后中位随访时间9个月,无死亡病例及复发转移。结论:腹腔镜保留左结肠动脉的括约肌间切除术,术者需具备一定的腹腔镜手术经验,掌握不同的术式及不同视野下的操作技术。

Objective:To preliminarily explore the feasibility and safety of laparoscopic intersphincteric resection(ISR)with preservation of the left colonic artery for low rectal cancer.Methods:The clinical data of 13 patients with low and ultra-low rectal cancer who underwent laparoscopic-assisted ISR with preservation of the left colonic artery from Dec.2019 to Dec.2021 were retrospectively analyzed.The surgeries were performed by the same group of surgeons using the five-port method.Results:The operations were successfully completed,with an average operation time of(210.3±82.6)min,an average intraoperative blood loss of(33.6±18.7)mL.The a nal preservation rate was 100%(13/13),and overall complication rate was 15.4%(2/13),with 1 case of anastomotic leakage(grade A leakage)and 1 case of membranous anastomotic stenosis.The mean number of lymph nodes harvested was(16.6±3.7).The median postoperative follow-up time was 9 months,during which there was no death or tumor recurrence and metastasis.Conclusions:Laparoscopic ISR with preservation of the left colonic artery is a process of gradual accumulation of techniques,and the surgeons need to have certain laparoscopic surgical techniques and experience,master different surgical styles and operations in different fields of view.