腹腔镜经肛门结肠肛管吻合在低位直肠癌保肛手术中的应用

目的探讨腹腔镜下低位直肠癌根治术中经肛门结肠肛管吻合术（腹腔镜改良Parks手术）的临床应用。方法回顾性分析2009年3月至2012年4月期间65例采用腹腔镜改良Parks手术患者的临床资料，评估其术后并发症以及肛门控粪、排尿和性功能状况。结果全组患者随访6～38月，术后出现吻合VI瘘2例，吻合口狭窄3例，发生肝转移1例，无局部复发病例。术后6月、1年和2年对排粪情况满意者分别占61．5％（40／65）、84．2％（48／57）和88．9％（40／45）。术后1月排尿功能障碍发生率为10．8％（7／65）；男性患者术后1月勃起功能障碍发生率为19．4％（7／36），射精功能障碍发生率27．8％（10／36）。女性患者术后1月对性生活满意者占65．5％（19／29）。结论腹腔镜改良Parks手术可以提高低位直肠癌患者的的保肛率和较满意的控粪、排尿及性功能。

Application of laparoscopic transanal coloanal anastomosis in sphincter-preserving surgery for low rectal cancer

Objective To evaluate the efficacy of laparoscopic transanal coloanal anastomosis （modified Parks procedure） in sphincter-preserving surgery for low rectal carcinoma. Methods Clinical data of 65 low rectal cancer patients undergoing laparoscopic modified Parks procedure from March 2009 to April 2012 in our department were reviewed retrospectively. Fecal continence, urination and sexual function were evaluated. Results All the patients were followed up from 6 to 38 months after operation. Anastomotic leakage was found in 2 cases, anastomotic stricture in 3 cases, hepatic metastasis in 1 case. No local recurrence occurred. The ratio of satisfactory defecation function was 61.5% （40/65） in six months, 84.2% （48/57） in 1 year and 88.9% （40/45） in 2 years respectively. Urinary dysfunction was found in 7 patients（10.8%）. Among 36 male patients, 7 （19.4%） presented erectile dysfunction and 10（27.8%） ejaculation dysfunction. Among 29 female patients, sexual life of 19（65.5%） was satisfactory. Conclusion Laparoscopic modified Parks procedure in sphincter-preserving surgery for low rectal cancer can increase the ratio of sphincter-preserving, and improve the functional outcomes of defecation, sex and urination.