腹腔镜直肠癌根治术346例回顾性分析

目的 探讨腹腔镜直肠癌根治术的可行性和手术安全性.方法 回顾性分析2003年1月至2006年6月收治的直肠癌346例.其中282例(81.5%)肿瘤肛缘12cm以内.TNM分期为:0期3.8%;I期21.7%.:II期28.3%;Ⅲ期35.5%;N期10.7%.直肠癌原发灶T3/T4为230例(66.5%).所有患者未做术前放化疗,在术后均常规进行化疗.结果 本组患者80.3%保留了肛门括约肌,平均手术时间为223 min,中转开腹率为3.1%,总死亡率为24.7%.吻合口瘘发生率为2.0%,手术死亡率为0.平均摘除淋巴结数为15枚.平均远端无瘤切缘为2.8cm,周围切缘阳性患者18例(占5.2%).平均随访24个月,I～Ⅲ期患者的局部复发率为2.3%,转移率为12.4%.未发生切口种植转移.术后无一例患者出现排尿功能障碍.结论 本组病例证明了腹腔镜直肠癌根治性切除术的肿瘤学安全性和该手术的可行性以及手术的安全性,为临床体供了重要参数.

Laparoscopic radical surgery for rectal cancer :a retrospective analysis of 346 cases

Objective To evaluate the operative safety and feasibility of lapa-roscopic resection of rectal cancer perfornmed by the same operative team.Methods A retrospective,analysis,was made on 346 cases of rectal cancer at our hospital from January 2003 to Junuary 2006.282 patients ( 81.5%) had the tumor located below 12 cm from the anal verge.TNM stages were distributed as 0:I:Ⅱ:Ⅲ:Ⅳ=3.8%:21.7%:28.3%:35.5%:10.7%.230 patients(66.5%) had T3/T4 lesions.The patients did not receive Pre-operative chemoradiotherapy,but postoperative chemother-apy,was given to them.Results Sphincter-preserving operation,was done in 80.3% of them with a mean operative time of 223 minutes.The conversion rate for the opera-tion,was 3.1% and the overall morbidity rate,was 24.7%.Anastomotic leakage oc-curred in 2.0% of the patients.The operative mortality rate,was 0.The mean number of harvested nodes,was 15 and the mean distal tumor-free margin,was 2.8 cm.The cir-cumferential resection margin was positive in 18 petients(5.2%).Follow-up of 24 months on average showed a local recurrence rate of 2.3% in the stage I-Ⅲ patients.Systemic recurrence of the tumor occurred in 12.4% of the patients.Neither port-site recurrence nor urinary dysfunction were observed in all patients.Conclusions Lapa-roscopic resection of rectal cancer is safe with better mid-term outcomes.