腹腔镜直肠癌全直肠系膜切除术的临床应用

目的：探讨腹腔镜全直肠系膜切除术的临床应用。方法：回顾分析13例腹腔镜直肠全系膜切除术患者的临床资料。结果：13例均用腹腔镜完成手术,手术时间150-240min,平均165min,术中平均出血150ml。术后均无严重并发症发生,随访0.5-5年,无一例肿瘤复发,穿刺部位及造瘘口均无肿瘤种植。结论：腹腔镜全直肠系膜切除术具有较高的实用价值,在严格掌握手术适应证、不断提高手术技巧的基础上,腹腔镜直肠癌全直肠系膜切除术是可行的。     

TME原则下保肛手术治疗低位直肠癌24例临床分析

目的探讨全直肠系膜切除原则下低位直肠癌保肛术及适应症。方法对2004~2008年24例低位直肠癌在全直肠系膜切除原则下施行保肛手术的临床资料进行回顾分析。结果24例全直肠系膜切除原则下低位直肠癌保肛术患者均一期愈合,近期无并发症及局部复发,肛门括约肌功能正常,术后对性功能和泌尿功能的影响较小。结论对低位直肠癌患者应根据肿瘤下缘距齿状线距离结合Dukes分期及病理分化程度,在全直肠系膜切除原则下行低位直肠癌保肛术,能有效降低局部复发率,在一定程度上能提高患者的生活质量。     

TME及双吻合器在中低位直肠癌保肛手术的应用

目的探讨全直肠系膜切除、双吻合器技术在中低位直肠癌保肛手术中的应用价值。方法回顾性分析25例采用直肠全系膜切除、双吻合器行中低位直肠癌前切除术患者的临床资料。结果全组无手术死亡,术后无大便失禁,吻合口漏发生1例,吻合口狭窄2例。术后随访2-5年,局部复发1例。结论直肠全系膜切除可降低中低位直肠癌术后局部复发,而双吻合器的应用能提高中低位直肠癌的保肛率。     

男性低位直肠癌患者腹腔镜下全直肠系膜切除联合直肠经肛门拖出式吻合术的治疗体会

目的探讨男性低位直肠癌患者行腹腔镜下全直肠系膜切除联合直肠经肛门拖出式吻合术的治疗效果。方法回顾性总结23例男性低位直肠癌患者保肛手术成功的经验。结果本组病例行腹腔镜全直肠系膜切除术,充分游离直肠下端并离断肿瘤近端后,将远端直肠和肿瘤一并经肛门拖出,闭合器切闭肿瘤远端,管状吻合器行直肠与降结肠端端吻合。23例患者均成功保留肛门,无手术死亡。术中及术后病理检查残端无肿瘤残留,术后均未发生吻合口漏。结论针对骨盆相对狭窄的男性患者,利用腹腔镜行全直肠系膜切除联合直肠经肛门拖出式吻合术,对于低位直肠癌保留肛门是安全可靠的,它可以简化手术难度,提高低位直肠癌保肛手术的成功率。     

腹腔镜结直肠癌根治术210例临床分析

目的:探讨腹腔镜结直肠癌根治术的临床价值.方法:回顾分析210例结直肠癌患者施行腹腔镜结直肠癌根治术的临床资料,并总结其手术方法及随访结果.结果:210例中无一例手术死亡,168例行直肠癌全直肠系膜切除,结直肠或结肛吻合术;42例行腹会阴联合切除术(Miles);术中出血平均70.5 ml;手术时间平均110 min;...     

腹腔镜 低位直肠癌 手工吻合 保肛术 肛外手工吻合在腹腔镜低位直肠癌保肛术中的应用

目的探讨肛外手工吻合技术在腹腔镜低位直肠癌保肛术中的应用价值。方法应用超声刀在腹腔镜下对15例低位直肠癌患者实施全直肠系膜切除原则的根治性手术,用肛外手工吻合的方式完成超低位结肠-直肠/肛管吻合术。结果15例患者手术经过均顺利,无中转开腹。术后发生吻合口瘘1例,无腹腔出血、感染、吻合口狭窄等并发症。手术时间125～270min,平均156min。术中出血30～180ml,平均70ml。住院时间9～14d,平均11d。15例术后随访2～37个月,平均14个月。术后局部无复发,远处肝转移1例。结论低位直肠癌行腹腔镜下超低位切除、肛外手工吻合保肛术是一种安全、经济、创伤小、疗效可靠的术式。     

腹腔镜直肠癌全直肠系膜切除术90列报告

目的 评价腹腔镜全直肠系膜切除术的临床疗效.方法 回顾分析2007年4月至2012年4月90例腹腔镜全直肠系膜切除术患者的临床资料.结果 82例用腹腔镜完成手术,手术时间180 ～ 260 min,平均205 min,术中平均出血150 ml,清除淋巴结总数平均为15个.术后均无严重并发症发生,随访1～4年,无肿瘤复发,穿刺部位及造瘘口均无肿瘤种植.结论 腹腔镜全直肠系膜切除术具有较高的实用价值,在严格掌握手术适应证、不断提高手术技巧的基础上,腹腔镜直肠癌全直肠系膜切除术是可行的.     

腹腔镜辅助TME直肠癌根治性切除前路吻合术:附42例报告

目的：探讨腹腔镜辅助全直肠系膜切除在直肠癌根治中的效果和方法。方法：对42例腹腔镜辅助全直肠系膜切除直肠癌根治前路吻合术的临床资料进行分析总结。结果：手术均经腔镜完成TME及保肛手术,术中直肠远端使用反复闭合器闭合,前路吻合采用吻合器完成。手术时间170~230 min,平均195 min。术中出血10~30 mL,平均15 mL。术后肠功能恢复平均时间32 h。1例术后并发排尿困难,1例术中并发皮下气肿。无切口感染,无吻合口漏。结论：腔镜辅助行TME直肠癌根治性切除前路吻合术是安全可行的。     

肛外手工吻合在腹腔镜低位直肠癌保肛术中的应用

目的 探讨肛外手工吻合技术在腹腔镜低位直肠癌保肛术中的应用价值.方法 应用超声刀在腹腔镜下对15例低位直肠癌患者实施全直肠系膜切除原则的根治性手术,用肛外手工吻合的方式完成超低位结肠-直肠/肛管吻合术.结果 15例患者手术经过均顺利,无中转开腹.术后发生吻合口瘘1例,无腹腔出血、感染、吻合口狭窄等并发症.手术时间125～270 min,平均156 min.术中出血30～180 ml,平均70 ml.住院时间9～14 d,平均11 d.15例术后随访2～37个月,平均14个月.术后局部无复发,远处肝转移1例.结论 低位直肠癌行腹腔镜下超低位切除、肛外手工吻合保肛术是一种安全、经济、创伤小、疗效可靠的术式.     

腹腔镜辅助下低位直肠癌根治术21例体会

目的 探讨腹腔镜下全直肠系膜切除(TME)治疗低位直肠癌的临床应用价值.方法 回顾性分析我院2007年1月至2008年3月期间21例行腹腔镜低位直肠癌手术患者的临床资料.结果 21例手术均成功,无中转开腹,平均手术时间160 min (110～260 min),术中平均失血50 ml (15～150 ml),术后平均住院时间9 d,发生吻合口漏1例,肠梗阻1例,排尿困难1例,术后随访1～14个月(平均9个月),随访率100%,无其他并发症和肿瘤复发表现.结论 腹腔镜辅助下TME治疗低位直肠癌安全、可行,且创伤小,疼痛轻,恢复快,掌握手术适应证及良好的腹腔镜手术技术和开腹直肠手术经验是手术成功的保证.     

腹腔镜全直肠系膜切除术中保留盆腔自主神经对术后男性患者性功能的影响

目的:对比腹腔镜及开腹全直肠系膜切除术中保留盆腔自主神经对男性患者术后性功能的影响。方法:回顾分析2011年6月至2015年6月92例直肠癌根治术(均行Dixon术)患者的临床资料,其中45例行腹腔镜下保留盆腔自主神经的全直肠系膜切除术(腹腔镜组),47例开腹行保留盆腔自主神经的全直肠系膜切除术(开腹组),对比两组患者术后勃起功能障碍、射精功能障碍发生率及术后1年盆腔局部复发情况。结果:术后1、3、6个月,开腹组勃起功能障碍、射精功能障碍发生率明显高于腹腔镜组,差异有统计学意义(P0.05);术后12个月后,两组差异无统计学意义(P0.05)。1年后两组患者盆腔局部复发率差异无统计学意义(P0.05)。结论:腹腔镜全直肠系膜切除术中保留盆腔自主神经在达到与开腹手术相同的根治效果的基础上,术后早期(6个月内)患者性功能恢复效果更好,且于术后12个月达到与开腹手术相同的保护患者性功能的效果,明显改善了男性患者的术后生活质量,具有较高的临床应用价值。     

Compatibility, indications, and limits of nerve sparing technique in lateral pelvic lymphadenectomy for advanced rectal carcinoma

The aim of radical surgical treatment of rectal cancer is to control the spread and prevent recurrence of the disease. In an attempt to improve the results of treatment of locally advanced rectal cancer, we advocate an extended surgical approach consisting of total mesorectal excision, lateral pelvic lymphadenectomy and the nerve sparing technique with resection of autonomic nerves whenever these fibers are affected by locally advanced tumor. Nine cases (9.2%) in a personal series of 98 patients with rectal carcinoma, operated on over the period from January 1992 to December 1997, underwent total mesorectal excision, lateral pelvic lymphadenectomy and the nerve sparing technique procedures for locally advanced extraperitoneal disease. In 7 patients with stage II or III disease, the 5-year survival rate was 80% and the 5-year disease-free survival rate 66.7% after a mean follow-up of 55 months. None of them experienced local recurrence, but one patient died of diffuse metastatic disease 50 months after surgery. One patient with stage IV rectal cancer died of disease 13 months postoperatively, while another patient with the same stage of disease is still alive with disease 26 months after surgery. One patient underwent liver resection for a solitary metastasis 25 months after the primary operation. Two patients suffered postoperatively from urinary retention with mild irregular flow at urodynamic testing, but no long-term urinary disturbances persisted. Retrograde ejaculation occurred postoperatively in one of the two patients who experienced urinary disorders, and another patient had erection disturbances. These sexual dysfunctions did not improve during long-term follow-up. Total mesorectal excision, lateral pelvic lymphadenectomy, and the nerve sparing technique, with resection of the autonomic nerves whenever these fibers are involved, allow satisfactory results to be achieved in terms of survival and functional outcome in patients with locally advanced rectal cancer. In western subjects, however, this procedure is safe only after careful patient selection.     

腹腔镜辅助中低位直肠癌手术治疗的体会

目的：探讨腹腔镜辅助治疗中低位直肠癌的安全性与可行性。方法：回顾分析76例中低位直肠癌患者腹腔镜手术的临床资料。结果：73例成功施行了腹腔镜手术,保肛率84.9%（62/73）,局部复发率0.06%（5/73）,均至少保留了一侧盆腔自主神经,无严重并发症发生。结论：遵循全直肠系膜切除（total mesorectal excision,TME）原则施行保留自主神经的腹腔镜手术可提高疗效及保肛率。     

Intraoperative parasympathetic nerve stimulation with tumescence monitoring during total mesorectal excision for rectal cancer

BACKGROUND: Unilateral or bilateral division of the parasympathetic nerves during resection of rectal cancer may result in sexual erectile dysfunction. The purposes of this project were twofold: to determine the ability to demonstrate penile tumescence in response to parasympathetic nerve stimulation after rectal cancer resection and to correlate the nerve stimulation response with clinical sexual function 6 months after operation. STUDY DESIGN: In 21 consecutive male patients with normal erectile function undergoing total mesorectal excision, cavernous nerve identification and integrity before and after pelvic dissection were assessed intraoperatively, both visually by an experienced surgeon and by using the CaverMap nerve stimulator. The minimal effective current necessary to produce a 2% increase in penile tumescence was recorded for both the left- and right-sided nerves, primarily the largest nerve trunk, S3. Postclearance stimulation data were then correlated with sexual function outcomes, specifically erection and orgasm at 6 months after surgery. RESULTS: The operating surgeon's visual assessment of the pelvic autonomic nerve's integrity after pelvic dissection was deemed intact in 20 of the 21 patients (95.2%). Of the 20 patients who were evaluated with CaverMap after completion of total mesorectal excision, 17 (85%) had tumescence response after nerve stimulation on either side, and 3 patients (15%) had unilateral response only. Of the 19 patients evaluated for sexual function 6 months after surgery, 18 (94.7%) had normal function, including the 3 patients with only unilateral nerve stimulation tumescence response. CONCLUSIONS: Intraoperative mapping of the parasympathetic nerve trunks with the CaverMap nerve stimulator may be a valuable aid to less experienced pelvic surgeons and may help in autonomic nerve preservation during total mesorectal excision clearance.     

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目的　探讨直肠癌术后局部复发的病因、诊断、再手术及并发症的防治。方法　对 35例直肠癌术后局部复发再手术者进行回顾性分析。结果　局部复发的 35例中 13例为吻合口复发 ,11例是远切缘距肿瘤 <3cm者。 9例盆腔淋巴复发者均是首次手术时有淋巴结转移的病例 ,其中 7例未做规范的淋巴结清扫。 12例未切除全部直肠系膜。结论　局部复发与首次手术时肠管切除不足 ,淋巴清扫不彻底 ,全直肠系膜切除不够及淋巴转移有关。定期复查 ,动态观察CEA有助于复发癌的早期发现和诊断。对能耐受手术又无广泛远处转移者给予再次手术 ,能获较好疗效     

腹腔镜直肠癌全直肠系膜切除术中保护盆自主神经的手术技巧

Laparoscopic radical resection of rectal neoplasms is still under clinical research currently due to the following 2 reasons. Firstly, compared with open surgery, the longterm efficacy of laparoscopic surgery remains unclear; secondly, the pelvic autonomic nerves are difficult to be exposed and easy to be damaged during the surgery under laparoscope. Till present time, our department has completed 800 cases of laparoscopic radical resection of colorectal neoplasms, in which rectal neoplasms accounted for 70%. For most cases, the pelvic autonomic nerves have been exposed and protected properly. This paper summarized the skills to protect the pelvic autonomic nerves in the laparoscopic total mesorectal excision used for the treatment of rectal neoplasms.     

经肛门切除内括约肌治疗超低位直肠癌的保肛手术47例临床经验

目的报告在直肠癌全系膜切除术（totalmesorectal excision TME）基础上采用内括约肌切除（intersphincter resection ISR）治疗超低位直肠癌的手术经验和初步结果。方法患者选自2000年3月至2008年12月的超低位直肠肿瘤患者47例。,男29例,女18例,年龄34～75岁。手术方式：腹部手术施行TME,会阴部手术施行ISR。术后随访,了解患者术后肛门功能、有无肿瘤的局部复发和转移。结果本组患者均施行该手术,手术无死亡。术后随访3个月-8年,平均3年10个月,46例手术后获得较好的肛门功能,Kirwan分级1～4级。2例手术后直肠癌局部复发,其中1例死亡。2例手术后肛门狭窄,再次手术扩肛。结论内括约肌切除（ISR）治疗超低位直肠癌的保肛手术,是一种安全可行的手术方式,可以达到在根治性的前提下保留肛门的目的。     

PPH在低位直肠癌保肛手术中的应用

目的分析在全直肠系膜切除术（TME）基础上采用PPH吻合低位保肛的手术经验和初步结果。方法回顾性分析2006年6月至2009年1月共15例低位直肠癌患者接受TME基础上PPH吻合器吻合保肛手术治疗的临床资料,术后随访6个月至3年,了解并发症、肛门功能、肿瘤局部复发情况。结果 15例患者手术均成功完成,无手术死亡;术后获得较好的肛门功能,无吻合口漏、肛门狭窄及局部复发。结论 PPH吻合器吻合低位保肛术在不影响肿瘤根治原则下,安全可行,在根治的前提下可良好地保留肛门功能。     

我国直肠癌诊断和治疗的现状

Colorectal cancer is one of the most common malignancies in the world, and rectal cancer accounts for a large percentage of this disease in Chinese patients. Surgical extirpation is the mainstay of therapy, Intraluminal ultrasound is highly accurate in detecting depth of invasion and lymph node metastasis, and is also helpful in preoperative staging of rectal cancer. Preoperative adjuvant therapy could down-stage tumors, improve the radical resection rates of advanced lower rectal cancer, increase the rate of sphincter-saving surgery, and decrease the local recurrence rate. Total mesorectal excision could signifi-candy decrease the local metastasis of rectal cancer, and rectal cancer resection with preservation of pelvic autonomic nerve is effective in preventing urinary or reproductive dysfunction. Recently, minimally invasive surgery has been introduced for the management of rectal cancer, and transanal endoscopic microsurgery is a new method with advantages in rectal cancer treatment.