中间入路腹腔镜辅助直肠癌高位前切除术26例报告

目的:探讨中间入路在腹腔镜辅助直肠癌高位前切除术中的操作技巧、应用价值及并发症。方法:回顾分析术中使用中间入路进行显露和操作的26例直肠上段癌和乙状结肠下段癌的临床资料。结果:手术均获成功,手术时间平均(110.3±43.8)min,术中出血平均(71.7±88.8)ml,术中无严重并发症发生。术后发生并发症2例(7.7%),1例切口感染,1例肠梗阻。平均住院(13.53±9.23)d。平均切除淋巴结(13±3.4)枚。经病理检查证实,除1例绒毛管状腺瘤、1例类癌外,余24例均为腺癌。按TNM分期,Ⅰ期8例,Ⅱ期11例,Ⅲ期7例。随访所有病例1~11个月,1例局部复发,无远处转移及肿瘤相关死亡病例。结论:中间入路腹腔镜辅助直肠癌高位前切除术是安全有效的手术径路。应用此径路能否达到与传统手术效果相同的肿瘤根治尚待进一步验证。

Laparoscopy-assisted high anterior resection for rectal carcinoma with a medial-to-lateral approach:a report of 26 cases

Objective:To investigate operative skills,application value and complications of the laparoscopy-assisted high anterior resection with a medial-to-lateral approach for rectal cancer.Methods:The retrospective analysis was made on clinical data of 26 patients with upper rectal and low sigmoid colon carcinoma who underwent laparoscopic operation with medial-to-lateral approach for exposure and operation.Results:All operations were successful.The mean operative time was(110.3±43.8)min and the average blood loss was(71.7±88.8)ml.No serious complications occurred during operation.Postoperative complications occurred in only 2 patients(7.7%),including 1 case of wound infection and 1 case of intestinal obstruction.The average hospital stay was(13.53±9.23)d.A mean of(13±3.4) lymph nodes were resected.Pathological examination confirmed that,in addition to 1 case of tubulovillous adenoma and 1 case of carcinoid tumor,the other 24 cases were all adenocarcinoma.Among them,according to TNM staging,there were 8 cases ofⅠ period,11 cases of Ⅱ period and 7 cases of Ⅲ period.Follow-up was achieved in 26 cases for 1 to 11 months,during which 1 patient had local recurrence.There were no distant metastasis cases and tumor-related deaths.Conclusions:Laparoscopy-assisted anterior resection using the medial-to-lateral approach is a safe and effective procedure for the treatment of rectal cancer.However,whether the surgical approach can achieve the same tumor radical cure with traditional surgery has yet to be further verified.