非医学中心医院复制基于膜解剖的腹腔镜直肠癌根治术的初步经验(附23例报告)

目的:探讨非医学中心医院复制基于膜解剖直肠癌根治术的可行性及应用价值。方法:回顾分析23例腹腔镜直肠癌手术(基于膜解剖术式)患者的临床资料,其中20例行经腹直肠癌根治术(Dixon),3例行经腹会阴联合直肠癌根治术(Miles)。记录手术时间、术中出血量、术后相关并发症情况、术后恢复情况等。结果:23例手术均获成功,手术时间120~280 min,平均(186.1±44.4)min;术中出血量5~60 mL,平均(17.0±14.2)mL;淋巴结数量5~21枚,平均(12.6±4.5)枚;住院8~17 d,平均(10.3±3.0)d。术后1例患者出现吻合口出血,经保守治疗后治愈,无手术死亡病例。结论:基于膜解剖的腹腔镜下直肠癌根治术安全性高,肿瘤根治性较好,可行性高,术者具备扎实的理论知识,操作认真,具备必要的手术器械,配合规范默契,完全可复制,适合在非医学中心医院推广。

Preliminary experience of replicating laparoscopic radical resection of rectal carcinoma based on membrane anatomy in non-academic center hospital:with a report of 23 cases

Objective:To investigate the feasibility of replicating radical resection of rectal cancer based on membrane anatomy in non-academic center hospital and to evaluate its application value.Methods:The clinical data of 23 cases of laparoscopic rectal cancer surgery(based on membrane anatomy)were analyzed retrospectively.Among them,20 patients were treated by transabdominal radical resection of rectal cancer(Dixon),3 cases were treated by transabdominal-perineal combined radical resection of rectal cancer(Miles).The operative time,intraoperative blood loss,postoperative complications and postoperative recovery were recorded.Results:All 23 patients successfully underwent laparoscopic rectal cancer surgery.The operative time was 120-280 min,with an average of(186.1±44.4)min.The intraoperative blood loss was 5-60 mL,with an average of(17.0±14.2)mL.The number of lymph nodes was 5-21,with the average of(12.6±4.5).The hospital stay was 8-17 d,with an average of(10.3±3.0)d.Postoperative anastomotic bleeding occurred in 1 case,which was cured after conservative treatment,and there was no operative death.Conclusions:Laparoscopic radical resection of rectal cancer based on membrane anatomy associates with high safety,good radical resection and high feasibility.With solid theories,careful operation,necessary surgical instruments,and tacit cooperation,this procedure can be repeatedly performed and is suitable for promotion in the non-academic center hospitals.