腹腔镜直肠癌前切除双吻合器吻合术103例临床分析

目的探讨腹腔镜直肠癌前切除双吻合器吻合术的安全性、可行性及临床疗效。方法回顾性分析2009年1月至2015年12月103例中低位直肠癌施行腹腔镜直肠癌前切除双吻合器吻合术资料。其中男59例,女44例,年龄32~85岁,平均61.6岁。肿瘤距肛缘7~12 cm。术前评估T1N0M026例,T2-4N1-3M077例。从腹腔镜腹部手术时间、术中出血量、淋巴结清扫数目、术后肛门排气时间、术后住院时间,术后并发症发生率、术后排便功能等评价手术质量。采用门诊检查和电话方式进行随访,随访时间至2015年4月。结果本组103例手术经过顺利均获成功,平均检出淋巴结12枚以上,行预防性横结肠和回肠造瘘术12例,3个月后还纳造口。术后3~5 d肠蠕动恢复肛门排气,术后平均11 d出院。术后病理为T_1-T_2N_0M_015例,T_2-4N_(1-3)M_082例,T_2-4N_1-3M_16例。术后随访3~50个月,平均26个月,术后发生吻合口漏3例(2.9%),2例经结肠腹部临时造口,3个月后还纳愈合,1例保守治疗,1个月后愈合;吻合口狭窄2病例(1.9%),均经扩张狭窄解除。局部肿瘤复发4例(3.8%)。结论腹腔镜中低位直肠癌前切除双吻合器吻合术,是安全可靠,符合微创原则,临床疗效满意。

Clinical analysis of laparoscopic resection of rectal cancer by using double-stapling anastomosis method,report of 103 cases

Objective To investigate the safety, feasiblity and clinical efficacy of laparoscopic resection of rectal cancer by using double-stapling anastomosis method. Methods From Jan 2009 to Dec 2015, 103 patients including 59 men and 44 women, aged 32-85 years (mean age of 61.6 years) underwent laparoscopic resection of rectal cancer by using double-stapling anastomosis method in Department of general surgery , General hospital of PLA Army.The tumors were 7-12 cm away from the anal margin.In preoperative assessment, there were 26 cases of T1 N0 M0 and 77 cases of T2-4 N1-3 M0 .Clinical data were analyzed retrospectively, including laparoscopic operation time, intraoperative blood loss, number of harvested lymph nodes, postoperative evacuating time, hospital stay, incidence of complications, anal function.Follow-up were lasted to April 2015 by using clinic service or telephone. Results For the present cohort of 103 cases, all of whom received successful operation, with an average of 12 lymph nodes detected, including 12 cases of preventive diverting stoma of transverse colon or ileum and closure operation 3 months later.Postoperative evacuating time were 3-5 days with average hospital stay of 11 days.The postoperative pathology showed T1-T2 N0 M0 in 15 cases, T2-4 N1-3 M0 in 82 cases and T2-4 N1-3 M1 in 6 cases.The patients were followed up for 3-50 months, with an average of 26 months.Three case (2.9%) of postoperative anastomotic leak was observed, 2 cases requiring temporary colostomy, which was closed and recovered 3 months later, 1 case received conservative treatment and were cured 1 month later.Two cases (1.9%) of stoma stenosis were observed, and were cured by dilatation.There was 4 cases of local recurrence (3.8%) . Conclusion Laparoscopic resection of rectal cancer by using double-stapling anastomosis method is mini-invasive , safe and feasible with satisfactory clinical efficacy .