腹腔镜联合内括约肌切除术治疗超低位直肠癌

目的：探讨腹腔镜全直肠系膜切除（TME）联合内括约肌切除术（ISR）治疗超低位直肠癌的可行性及其疗效。方法：对13例超低位直肠癌患者采用腹腔镜全直肠系膜切除联合内括约肌切除术（7例行部分内括约肌切除术,4例行次全切除术,2例行全切除术）,术后随访12～36个月,观察患者的控便情况、术后并发症和肿瘤局部复发情况。结果：所有患者手术切缘均阴性,远切缘距肿瘤下缘距离平均2.4cm（2.0～2.8 cm）,术中出血平均100 mL（50～150 mL）,手术时间平均4 h（3～5 h）。术后3个月内大便次数3～10次/d,术后1年大便次数1～4次/d。2例出现吻合口瘘。结论：采取腹腔镜全直肠系膜切除联合内括约肌切除术是治疗超低位直肠癌和保留肛门的可行途径,其肛门功能及治疗效果均令人满意。

Laparoscopic with intersphincteric resection in treatment of ultra-low rectal cancer

Objective：To probe the feasibility and curtive effect of laparoscopic total mesorectal excision（TME） combine with intersphincteric resection（ISR） in treatment of ultra-low rectal cancer.Methods：Intersphincteric resection with total mesorectal excision was performed in 13 patients with ultra-low rectal cancer（partial intersphincteric resection in 7 patients,subtotal intersphincteric resection in 4 patients,total intersphincteric resection in 2 patients）.The postoperative anal functionc,omplication incidence and local recurrence were evaluated during 12～ 36 months of follow-up.Results：All patients had curative intent with microscopic safety margins.The mean distal resection margin on the fixed specimen was 2.4 cm（range2.0～2.8 cm）i,nteroperative bleeding volume 100 mL（ranged 50～150 mL）,operation time 4 h（range 3～5 h）.Defecated frequency ranged from 3～10/d after 3 months,1～4/d after 1 year.Two anastomotic fistulas were observed.Conclusion：Laproscopic TME＋ISR is a feasible alternative in treatment of ultra-low rectal cancer and in perservation anal.Anal function and curability are satisfied.