腹腔镜低位直肠保肛术中直肠脱出技术应用的初步研究

目的：探讨直肠脱出技术在腹腔镜低位保肛术中的应用价值。方法：回顾分析2005年10月至2009年1月运用直肠脱出技术行腹腔镜低位直肠前切除术的20例低位直肠肿瘤病人的临床资料，探讨其手术操作步骤及术后恢复情况、肿瘤根治性效果和随访结果。结果：所有病例均未发生术中严重并发症和手术死广，无中转开腹手术：平均手术时间为（122＋801min，术中平均出m（50±70）mL，病人术后平均排气时间、留置导尿管时间及术后住院天数分别为（2．2±1．1）d、（4．9±2．4）d和（11．0±4．2）d。，每例病人的平均清扫淋巴结总数为（15±4）枚，肿瘤距下切缘平均距离为（2．2±1．1）cm。所有病人均获随访，中位随访时间19（2-36）个月，未发现局部复发和远处转移，排便功能恢复均较满意。结论：直肠脱出技术运用于腹腔镜低位直肠保肛术安全有效，可作为低位直肠肿瘤保肛术的有效技术。

Application of laparoscopy-assisted low anterior resection with a prolapsing technique

Objective To assess the outcome of laparoscopy-assisted low anterior resection with a prolapsing technique for low rectal tumor. Methods The surgical technique, oncological outcome, complications, and the short-term results were studied in 20 patients undergoing between October 2005 and January 2009, laparoscopy-assisted low anterior resection with a prolapsing technique for low rectal tumor. Results No case was converted to open operation. The mean operation time was （122±80） min, and the mean quantity of blood loss was （50±70） mL. The mean time for passage of flatus, duration of urinary drainage, and the length of postoperative hospital stay were （2.2±1.1） d, （4.9±2.4） d and （11.0±4.2） d respectively. The total number of lymph nodes harvest was （15±4） per case, and the mean distal margin from the tumor was （2.2±1.1） cm. The median follow-up time was 19（2-36） months. No local recurrence or metastasis was observed. Acceptable anal function results were obtained in the patients. Conclusions Laparoscopy-assisted low anterior resection with a prolapsing technique is a novel and saie radical procedure for sphincter-preservation.