腹腔镜超低位直肠癌经肛门外翻拖出切除吻合术的临床分析

目的探讨腹腔镜超低位(肿瘤下缘距肛缘小于5 cm)直肠癌经肛门外翻拖出切除吻合术的可行性。方法回顾性总结2006年12月至2009年12月期间我院46例行腹腔镜超低位直肠癌经肛门外翻拖出切除吻合术患者的临床资料,分析患者的术中情况、术后并发症及随访情况。结果 46例患者均顺利完成手术,无一例中转开腹,术中出血量(202±56)ml(100～290 ml),胃肠功能恢复时间(60±16)h(36～82 h)。无吻合口出血及吻合口漏发生。随访(31±5)个月(21～45个月),15例出现轻中度吻合口狭窄,1例局部复发,2例肝转移。所有患者在造瘘还纳术后10个月肛门控便、控气功能良好,无肛门失禁;造瘘还纳术后(4.5±1.2)个月(2～10个月)排便功能逐渐恢复正常。结论腹腔镜超低位直肠癌经肛门外翻拖出切除吻合术安全、可行,疗效满意。

Clinical Analysis of Laparoscopic-Assisted Transanal Everted Pull-Through Resection and Anastomosis for Ultra-Low Rectal Cancer

Objective To investigate the feasibility of laparoscopic-assisted transanal everted pull-through resection and anastomosis in the treatment for ultra-low rectal cancer(the inferior margin of the tumor from the anal margin of less than 5 cm).Methods From December 2006 to December 2009,46 patients with ultra-low rectal cancer had been undergone laparoscopic-assisted transanal everted pull-through resection and anastomosis.The intraoperative condition,postoperative complications,and the result of follow-up were analyzed retrospectively.Results The operation was successfully performed on all the patients.The intraoperative blood loss was(202±56)ml(100-290 m1).The time of recovery of gastrointestinal function was(60±16)h(36-82 h).No anastomotic bleeding or stomal leak was observed.All the patients were followed-up for(31±5)months(21-45 months),15 patients developed mild to moderate anastomotic stricture,1 local recurrence,and 2 liver metastasis.All the patients had no anal incontinence 10 months after stoma closure operation,the defecation of all the patients became normal(4.5±1.2)months(2-10 months)later.Conclusions Laparoscopic-assisted transanal everted pull-through resection and anastomosis for ultra-low rectal cancer is safe and feasible,and the effect is satisfactory.