低位直肠癌前切除单吻合器吻合术40例

目的:探讨低位直肠癌前切除单吻合器吻合术的临床疗效.方法:回顾分析我院2000年6月至2005年6月低位直肠癌前切除单吻合器吻合术40例临床资料.结果:全组无手术死亡病例,未发生骶前出血及吻合口瘘病例,术后排尿困难2例(5%),经留置导尿,术后2周左右自行恢复,吻合口狭窄3例(7.5%),经扩肛3月左右治愈.术后随诊1年至5年,无吻合口复发,盆腔局部复发2例(5%),肝转移1例(2.5%),复发病人均已死亡.结论:低位直肠癌前切除单吻合器吻合术,遵循TME原则,是一种安全实用的手术方式,降低了低位直肠癌术后的复发率及并发症的发生,提高了低位直肠癌的保肛率.     

腹腔镜直肠癌低位前切除术中保留左结肠动脉对术后并发吻合口漏的影响

目的:探讨腹腔镜直肠癌低位前切除术中左结肠动脉(LCA)的保留对预防术后并发吻合口漏的临床价值。方法:回顾性研究。纳入2017年8月—2019年12月濉溪县医院普外科直肠癌患者32例,其中男14例、女18例,年龄13～89岁,中位年龄51岁。32例均行腹腔镜直肠癌低位前切除术,术中保留左结肠动脉的15例纳入观察组,未保...     

腹腔镜辅助经肛全直肠系膜切除术在低位直肠癌保肛根治术中的应用研究

目的:探讨腹腔镜辅助经肛全直肠系膜切除术（Lap-TaTME）在低位直肠癌保肛根治手术中的安全性、近期临床疗效。方法:回顾性队列研究。纳入2019年4月—2020年8月蚌埠医学院第一附属医院胃肠外科85例行低位直肠癌根治术患者的临床资料,其中男52例、女33例,年龄40~74岁。患者按照手术方式不同分为Lap-TaTM...     

左结肠动脉保留在腹腔镜下直肠癌根治术中的临床价值

目的 探讨腹腔镜下直肠癌根治术中保留左结肠动脉的临床价值。方法 回顾性分析我院行腹腔镜下直肠癌根治术的93例直肠癌患者的临床资料,将术中保留左结肠动脉的48例患者纳入保留组,术中未保留左结肠动脉的45例患者纳入未保留组。比较2组患者围术期相关指标、并发症发生情况及术后1、2、3年生存率。结果 与未保留组比较,保留组患者首次肛门排气时间、肠鸣音恢复时间及首次进食时间缩短,术中失血量减少,手术时间延长,差异均有统计学意义（P<0.05）;2组患者淋巴结清扫数比较差异无统计学意义（P>0.05）。2组术后并发症发生率及术后1、2、3年生存率比较,差异均无统计学意义（P>0.05）。结论腹腔镜下直肠癌根治术中保留左结肠动脉可减少术中出血量,促进患者术后胃肠功能恢复,且不会增加并发症,更符合人体解剖学结构理念。     

肠灌洗在急诊左半结肠切除一期吻合术中的应用

目的：探讨左半结肠癌致急性低位肠梗阻的外科处理方法。方法：回顾性分析2001年1月—2003年1月手术探查的急性低位肠梗阻病例中25例结肠癌性梗阻的临床资料。结果：除1例晚期结肠癌因腹腔广泛转移无法根治仅行结肠造口外，余24例行左半结肠切除一期吻合术治疗24例，均痊愈出院。结论：即便为术中确诊的结肠癌性急性肠梗阻，也应该争取手术，只要适应证掌握恰当，一期切除吻合术是安全可靠的。     

腹腔镜辅助下48例低位直肠癌的保肛手术治疗

随着腹腔镜技术的日益成熟,腹腔镜结直肠癌手术已经普遍开展。与传统开腹手术相比,腹腔镜结直肠癌手术具有创伤小、肠道功能恢复快、能较早进食和下床活动、不增加手术并发症、住院时间短等优点,能显著提高患者术后生活质量为广大患者所接受[1]。我院2008年12月至2011年5月共完成腹腔镜下低位直肠癌保留肛门手术48例,取得了良好的近期效果。现报告如下。     

“四步法”保留左结肠动脉在腹腔镜下直肠癌根治术应用研究

目的 探讨“四步法”保留左结肠动脉在腹腔镜下直肠癌根治术中的应用效果。方法 选择2018年11月至2020年12月于阜阳市人民医院收治的120例拟行腹腔镜下直肠癌根治术患者,其中男性75例,女性45例;年龄29～92岁,平均年龄62.51岁;合并糖尿病14例,高血压18例,冠心病3例;TNM分期Ⅰ期21例,Ⅱ期38例,Ⅲ期61例;肿瘤分化程度低分化16例,中分化69例,高分化35例。依照随机数表法分为试验组和对照组,每组60例。其中试验组采用“四步法”保留左结肠动脉,对照组采用不保留左结肠动脉。比较2组手术时间、术中出血量、住院时间,淋巴结清扫总数和253淋巴结清扫数目,术后排气时间、肠鸣音恢复时间、卡氏评分,吻合口瘘、吻合口狭窄发生率。结果 试验组手术时间、术中出血量、住院时间与对照组相当[（136.28±16.53） min vs (134.91±15.47) min、（54.37±9.02） mL vs (52.44±8.86) mL、（16.35±2.23） d vs (16.17±2.15) d],差异无统计学意义（P> 0.05）。试验组淋巴结清扫总数和253淋巴结清...     

腹腔镜辅助下直肠外翻拖出式手术治疗直肠癌的临床效果分析

<正>我国直肠癌发病率居世界前几位,随着双吻合器的应用,在直肠癌手术中保肛率已经有了明显提升[1]。虽然腹腔镜手术创伤小、恢复快,但对于超低位的直肠癌,使用内镜手术切割时,操作十分困难,并且容易残留肿瘤[2]。我科对2011年6月至2012年6月收治的40例患者采用腹腔镜辅助下直肠外翻拖出式手术治疗,效果明显,现报告如下。1资料与方法1.1临床资料回顾性分析我院2010年12月至2012年6月收治的40位     

低位直肠癌前切除综合征的发病机制及防治研究

随着直肠癌的发病率不断上升,越来越多的患者选择接受低位直肠肿瘤切除术,术后出现的一系列便频、便急、气便失禁等排便功能障碍称为低位前切除综合征（LARS）。本文通过检索国内外关于LARS的文献,对其发病机制及预防进行研究,同时对其中西医治疗进行综述,旨在为临床诊治LARS提供参考。     

颈前外侧入路枕—椎动脉吻合术的应用解剖

目的 为经颈前外侧入路行枕-椎动脉吻合术提供应用解剖学资料。方法 在16具(32侧)常规防腐的成年尸体标本上解剖观测枕动脉、椎动脉以及手术入路有关的解剖学。结果 枕动脉其起点部外径为0.2±0.02cm,枕动脉沟部外径0.19±0.02cm,其间长度为4.4±1.1cm,起点距寰椎横突1.8±0.7cm,距枢椎横突1.3±0.4cm,寰枢椎横突间椎动脉的外径为0.36±0.04cm。有18.8％枕动脉发支平面高,血管蒂较短。结论 经颈前外侧入路可以行枕-椎动脉端侧吻合,但技术难度较后入路大。     

Abdominoperineal resection does not decrease quality of life in patients with low rectal cancer

PURPOSE:

Issues related to body image and a permanent stoma after abdominoperineal resection may decrease quality of life in rectal cancer patients. However, specific problems associated with a low anastomosis may similarly affect quality of life for patients undergoing low anterior resection. The aim of this study was to compare quality of life of low rectal cancer patients after undergoing abdominoperineal resection versus low anterior resection.

METHODS:

Demographics, tumor and treatment characteristics, and prospectively collected preoperative quality-of-life data for patients undergoing low anterior resection or abdominoperineal resection for low rectal cancer between 1995 and 2009 were compared. Quality of life collected at specific time intervals was compared for the two groups, adjusting for age, body mass index, use of chemoradiation, and 30 days postoperative complications. The short-form-36 questionnaire was used to determine quality of life.

RESULTS:

The query returned 153 patients (abdominoperineal resection  =  68, low anterior resection  =  85) with a median follow-up of 24 (3-64) mo. The after abdominoperineal resection group had a higher mean age (63 ± 12 vs. 54 ± 12, p < 0.001) and more American Society of Anesthesiologists classification 3/4 patients (65 percent vs. 43 percent, p  =  0.03) than low anterior resection. Other demographics, tumor stage, use of chemoradiation, overall postoperative complication rates, and quality-of-life follow-up time were not statistically different in both groups. Patients undergoing abdominoperineal resection had a lower baseline short-form-36 mental component score than those undergoing low anterior resection. However, 6 mo after surgery this difference was no longer statistically significant and essentially disappeared at 36 mo after surgery.

CONCLUSION:

Patients undergoing abdominoperineal resection for low rectal cancer have a similar long-term quality of life as those undergoing low anterior resection. These findings can help clinicians to better counsel patients with low rectal cancer who are being considered for abdominoperineal resection.     

不同CO2压力对腹腔镜直肠癌根治术患者术中应激反应及胃肠功能的影响

目的对比分析腹腔镜直肠癌根治术中不同二氧化碳(CO2)气腹压力对患者应激反应及胃肠功能的影响。方法选择2014年3月至2019年4月在四川省安岳县人民医院接受腹腔镜根治术治疗的93例直肠癌患者,根据随机数字表法将其分为低、中、高气腹压力组,每组31例。所有患者手术方式、麻醉方法、用药等均一致,术中低气腹压力组CO2气腹压力为10 mmHg,中气腹压力组为12 mmHg,高气腹压力组为15 mmHg;记录并比较3组患者气腹持续时间、术中失血量、手术时间,分别于入室时(T0)、注气针穿刺时(T1)、气腹成功建立时(T2)及放气后10 min(T3)采集患者血液样本,检测患者皮质醇、肾上腺素、血浆D-乳酸水平;记录并比较3组患者术后首次排气、排便、肠鸣音、进食等用时及术后并发症发生情况。结果各组患者手术相关指标及并发症发生率比较差异无统计学意义(P>0.05);3组在T1、T2、T3的皮质醇、肾上腺素、血浆D-乳酸水平均较T0升高,差异有统计学意义(P<0.05);高气腹压力组各时点皮质醇、肾上腺素水平均高于其他组,差异有统计学意义(P<0.05);高气腹压力组胃肠功能恢复用时最长(P<0.05)。结论在10~15 mmHg的CO2气腹压力范围内均可顺利开展腹腔镜直肠癌根治术,且不会影响患者术后胃肠道功能的恢复,但随着压力的增加,患者术中应激反应加重,肠黏膜损伤情况较明显,气腹压力应以10~12 mmHg为宜。     

三维高清腹腔镜在腹腔镜直肠癌根治术中的应用

目的探讨3D高清腹腔镜在腹腔镜直肠癌根治术中的临床应用价值。方法2013年5月-11月,分别采用3D高清腹腔镜（30组）和2D高清腹腔镜（20组）行腹腔镜直肠癌根治术各30例,对比2组在手术持续时间、术中失血量、住院费用等方面的差异。结果3D组手术持续时间为（2．4±0．6）h,2D组为（3．0±0．8）h,差异有统计学意义（P=0．002）。3D组术中失血量（70±14）ml,2D组（80±16）ml,差异无统计学意义（P=0．013）。住院费用3D高清腹腔镜组（6．3±1．2）万元,2D高清腹腔镜组（6．5±1．3）万元,两组相比无统计学上差异（P=0．538）。结论3D高清腹腔镜能提供清晰的三维立体视觉,良好的深度感,可实现精确操作,缩短手术时间和减少出血量。3D高清视野下能更快地提高外科医生的腹腔镜手术操作能力。     

中低位直肠癌患者低位前切除术对肛门直肠功能影响研究

目的：研究中低位直肠癌患者手术对肛门直肠功能的影响。方法：选择2012年1月至2015年1月在我院就诊的中低位直肠癌患者100例,患者肿瘤远侧缘距肛缘距离≤5 cm为低位组,肿瘤远侧缘距肛缘距离5~10 cm为中位组,低位组、中位组患者各50例,所有患者均采用低位前切除术,采用Hida肛门直肠临床功能评分系统对两组患者的肛门直肠功能进行评分,观察患者排便情况,采用肛门直肠功能压力检测仪对患者进行检测。结果：术后低位组患者每日出现便失控、每周出现便失控、排气失控、排液性便失控、排固性便失控等发生率均显著高于中位组,中位组中偶尔便失控、排便功能正常发生率高于低位组,低位组患者排便功能较中位组差,差异有统计学意义(P<0.05),术前两组患者的肛门直肠临床功能评分比较差异无统计学意义(P>0.05),术后3、6、12个月时,低位组患者的肛门直肠临床功能评分较中位组高,差异有统计学意义(P<0.05);术后,中位组患者肛管最大收缩压、肛管静息压、肛管最大收缩时间、直肠肛门抑制反射压力下降等均显著高于低位组,低位组患者肛门直肠测压较中位组差,差异有统计学意义(P<0.05)。结论：低位直肠癌患者手术后肛门直肠功能障碍较中位直肠癌患者显著,在中低位直肠癌患者治疗时,应全面评估患者肛门直肠功能,争取保留患者肛门功能。     

Rectourethralis muscle and pitfalls of anterior perineal dissection in abdominoperineal resection and intersphincteric resection for rectal cancer

When performing nerve-sparing abdominoperitoneal resection or intersphincteric resection of lower rectal cancer, difficulty is sometimes encountered during dissection, separation and treatment in the area anterior to the anorectum passing through the levator hiatus between the bilateral levator ani slings owing to missing the surgical plane or venous bleeding. The rectourethralis muscle, which is a mass of smooth muscle, occupies the levator hiatus. The present histological study using nine male cadaveric specimens demonstrated that: (i) the external anal sphincter is likely to be tightly connected to the rectourethralis muscle; (ii) the rectal muscularis propria communicates with the rectourethralis muscle; (iii) the anorectal veins take a tortuous course across the rectourethralis muscle; (iv) Denonvilliers' fascia ends at the rectourethralis muscle; and (v) the rectourethralis muscle provides posterior attachment for the rhabdosphincter. Moreover, the cavernous nerve has been reported to penetrate the rectourethralis muscle. Therefore, careful treatment of the muscle seems to be necessary to avoid male sexual dysfunction. Owing to muscle fiber communications between the rectal muscularis propria and the rectourethralis muscle, and the fact that Denonvilliers' fascia terminates in the rectourethralis muscle, the surgical plane would tend to deeply penetrate the muscle mass. However, mass ligation of the anterior tissues for control of venous bleeding should be avoided. When the tumor is non-anterior, an abdominal surgical plane behind Denonvilliers' fascia is recommended to avoid excess invasion into the rectourethralis muscle.     

综合康复锻炼对改善低位直肠癌患者术后前切除综合征的效果

目的:探讨综合康复功能锻炼对改善低位直肠癌术后患者前切除综合征(anterior resection syndrome,ARS)的护理效果.方法:选择低位直肠癌术后并发ARS的98例患者,按住院号的顺序随机分为对照组和综合组,其中对照组49例患者采取常规盆底相关肌肉力量锻炼方案;综合组49例患者采取盆底肌锻炼与神经康复锻炼,分别比较两组患者干预前及干预后1,3,6个月时两组患者的前切除综合征评分(low anterior resection syndrome score,LARSS)及生存质量情况.结果:两组在干预前和干预后1个月时LARSS评分,差异无统计学意义(P＞0.05),综合组在干预后3个月和6个月时LARSS评分明显低于对照组,差异有统计学意义(P＜0.05);两组在时间效应、组间效应及时间组间效应值,差异均具有统计学意义(P＜0.05);两组在干预前及1个月时生活质量各维度评分,差异无统计学意义(P＞0.05);在干预后3个月和6个月时除环境功能外综合组患者的生活质量其他维度评分均高于对照组,差异有统计学意义(P＜0.05);除环境功能组间效应外,两组患者在生活质量所有指标的时间效应、组间效应及时间-组间效应,差异有统计学意义(P＜0.05).结论:通过开展盆底肌力锻炼联合神经康复锻炼较单纯盆底肌力锻炼更能够快速改善低位直肠癌术后ARS症状,对改善患者生存质量更为显著,在临床值得进一步推广.     

The utility of longitudinal slicing method for rectal specimen: pathological analysis of circumferential resection margin of intersphincteric resection for low‐lying rectal cancer

The pathological assessment of the resection margin of rectal cancer is important to predict clinical outcome. The transverse slicing method of rectal specimens is recommended in Western countries. However, in Japan the longitudinal slicing method is traditionally advocated. The aim of this study was to assess the advantages of the longitudinal slicing method. The subjects were 197 consecutive patients with primary rectal cancer who underwent curative intersphincteric resection from 2000 to 2013. The resected rectal specimens were cut into 12 slices in the direction of the long axis. Resection margin was considered positive when it was less than or equal to 1 mm. Resection margin was positive in 23 patients (12%). They were classified into two groups, namely the DEEP group (n = 16, 70%), when the resection margin corresponded to the deepest tumor invasion area, and the ENTRY group (n = 7, 30%), when resection margin was around the initial cutting point of the anal canal. It was shown that resection margin tends to be positive not only in the deepest tumor invasion area but also in the entry area of the anal canal. The longitudinal slicing method may have some advantages for accurate assessment of resection margin especially in low‐lying rectal cancer.     

超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用

目的:研究超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用价值。方法:选取90例择期进行腹腔镜结直肠癌根治术患者作为研究对象,随机分为观察组和对照组,各45例。对照组采用传统腰麻联合丙泊酚麻醉,观察组采用超声引导下腰方肌阻滞联合丙泊酚麻醉,比较两组患者术中（麻醉后5、15、30、60 min）收缩压（SBP）、舒张压（DBP）、心率（HR）和术后不同时间段的疼痛评分（VAS评分）,以及加用镇痛药情况和肠道恢复排气时间和术后48 h内不良反应发生情况。结果:两组患者SBP、DBP、HR组间、不同时间点及交互差异均有统计学意义（P<0.05）,且观察组麻醉后上述指标波动较对照组小（P<0.05）;麻醉前,两组患者皮质醇、肾上腺素水平无显著差异（P>0.05）,麻醉后各时间点观察组患者上述指标水平均显著低于对照组（P<0.05）;两组患者VAS评分组间、不同时间点及交互差异均有统计学意义（P<0.05）,且观察组术后各时间点VAS评分均显著低于对照组（P<0.05）;观察组不良反应发生率显著低于对照组（8.89% vs 24.44%, P<0.05）;观察组患者加用镇痛药的人数、剂量和肠道恢复排气时间均显著少于对照组（P<0.05）。结论:超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌手术中具有良好、稳定的麻醉效果,可有效缓解患者疼痛,减少术后不良反应发生。     

Comparison of percutaneous microwave ablation and laparoscopic resection in the prognosis of liver cancer

The effect of percutaneous microwave ablation and laparoscopic resection on the prognosis of liver cancer was investigated. Ninety patients with liver cancer treated at our hospital from March 2010 to March 2012 were divided into group A and group B (n=45) by using a random number table, and the surgical conditions and the prognosis were compared. The surgical conditions of patients in group A were significantly better than those in group B (P<0.05). The incidence of complications in group A was 6.67%, which was obviously lower than that of group B (P<0.05). The local recurrence rate of group A was 20.00%, and that of group B was 8.89%, which showed a significant difference (P<0.05). The two groups did not differ significantly in terms of either total recurrence rate (P>0.05) or 1-year, 2-year and 3-year survival (P>0.05). Both percutaneous microwave ablation and laparoscopic resection had a good long-term efficacy in liver cancer. However, percutaneous microwave ablation was superior as it caused less invasiveness, reduced the incidence of complications and improved prognosis of liver cancer.