腹腔镜低位直肠癌根治套入式吻合保肛术的临床应用

目的 探讨腹腔镜低位直肠癌根治套入式吻合保肛术式的安全性和可行性.方法 2011年3～4月间北京军区北京总医院对5例低位直肠癌患者施行腹腔镜低位直肠癌经肛门切除套入式吻合保肛术.用超声刀完成肠系膜根部周围淋巴结清扫,肠系膜下动静脉根部结扎切断,直肠游离至尾骨尖肿瘤远端5 cm;采用5针悬吊法暴露肛门术野,距齿状线上1 cm处环形切开,沿黏膜下锐性向上剥离至肛提肌平面,切断直肠,将直肠肿瘤及远端乙状结肠一并从肛门移出体外切除,行套入式近端结肠全层与直肠黏膜及黏膜下吻合.结果 5例患者腹腔镜手术均获成功,平均手术时间178 min,平均术中出血量76 ml;平均淋巴结检出数目14枚.术后3 d肠蠕动恢复,无一例出现术后并发症,腹部及肛门未见手术切口及明显瘢痕,平均术后住院时间12 d.结论 腹腔镜低位直肠癌根治套入式吻合保肛术安全、可行,腹部无手术切口.

Abstract：

Objective To investigate the safety, feasibility and clinical outcomes of laparoscopic sphincter-preserving proctectomy for low rectal cancer using transanal telescopic anastomosis. Methods Five patients underwent laparoscopic sphincter-preserving proctectomy for low rectal cancer using transanal telescopic anastomosis between March 2011 and April 2011 at the General Hospital of Beijing Military Command. After lymph node dissection around the mesentery using harmonic scalpel, the root of the inferior mesenteric vessel was ligated and transected. Rectal dissection was further carried out until 5 cm distal to the lower margin of the tumor. A circumferential incision was made 1.0 cm above the dentate line using 5 support stitches for exposure. The submucous layer was striped upward to the level of the levator ani, and rectum was transected. Rectum and sigmoid colon were extracted transanally and removed. Finally, colonanal anastomosis was made using telescopic technique. Results Five patients underwent the procedure successfully. The mean operative time was 178 minutes. The mean intraoperative blood loss was 76 ml. The mean lymph nodes retrieval was 14. Bowel function recovered after a mean of 3 days. There were no postoperative complications. No obvious scars were seen in the abdomen or the anus. The mean hospital stay was 12 days. After one year of follow-up, all the patients survived cancer-free. Conclusions Laparoscopic anterior resection with sphincter preservation by transanal telescopic anastomosis for low rectal cancer is feasible and safe. Abdominal incision is minimal. However, the long-term outcomes require further investigation.

Clinical study of laparoscopic sphincter-preserving proctectomy for low rectal cancer using transanal telescopic anastomosis

Objective To investigate the safety, feasibility and clinical outcomes of laparoscopic sphincter-preserving proctectomy for low rectal cancer using transanal telescopic anastomosis. Methods Five patients underwent laparoscopic sphincter-preserving proctectomy for low rectal cancer using transanal telescopic anastomosis between March 2011 and April 2011 at the General Hospital of Beijing Military Command. After lymph node dissection around the mesentery using harmonic scalpel, the root of the inferior mesenteric vessel was ligated and transected. Rectal dissection was further carried out until 5 cm distal to the lower margin of the tumor. A circumferential incision was made 1.0 cm above the dentate line using 5 support stitches for exposure. The submucous layer was striped upward to the level of the levator ani, and rectum was transected. Rectum and sigmoid colon were extracted transanally and removed. Finally, colonanal anastomosis was made using telescopic technique. Results Five patients underwent the procedure successfully. The mean operative time was 178 minutes. The mean intraoperative blood loss was 76 ml. The mean lymph nodes retrieval was 14. Bowel function recovered after a mean of 3 days. There were no postoperative complications. No obvious scars were seen in the abdomen or the anus. The mean hospital stay was 12 days. After one year of follow-up, all the patients survived cancer-free. Conclusions Laparoscopic anterior resection with sphincter preservation by transanal telescopic anastomosis for low rectal cancer is feasible and safe. Abdominal incision is minimal. However, the long-term outcomes require further investigation.