腹腔镜直肠癌切除术及低位保肛16例临床探讨

目的探讨腹腔镜直肠癌切除术治疗低位直肠癌、低位结肠-肛管吻合术保肛的可行性。方法在腹腔镜下对16例低位直肠癌患者实施低位、超低位、保肛吻合术。结果16例手术均获成功,保肛率100%。手术时间180~290m in,平均260m in;术中出血50~100m l,平均80m l;术后1~2d恢复胃肠功能并下床活动,住院时间6~14d,平均9d。术后止痛剂应用6例,术中及术后无近期并发症发生。结论腹腔镜全直肠系膜切除(TME)术治疗直肠癌,创伤小、出血少、保肛率高、术后疼痛轻、恢复快,对自主神经丛的保护更准确,术后肛门括约肌功能、排尿功能良好。

Clinical study of 16 cases of laparoscopic low rectal cancer surgery with anal sphincter preservauon

Objective To assess the feasibility of laparoscopic operations and preservation of anal sphincter for low rectal cancer.Methods Laparoscopic surgery and colo-anal anastomoses were performed on 16 patients with low rectal cancer.Results Sixteen low colo-analanastomoses were successfully completed with totally laparoscopically.The operation time was 260 min(180~290min) while operative bleeding was 80ml(50~100ml).The time of bowel movement returned and the time to resume post-operatively diet was 1~2 days after the operation.Six patients had postoperative analgesic requirement.Average hospital stay was 9 days(6~14days)and there were no intraoperative or postoperative complication in all 16 patients.Conclusion Laparoscopic low colo-anal anastomoses for low rectal cancer is a perspective minimally invasive technique,which is feasible,safe,effective and has dramatically higher rates of sphincter preservation,accuracy of the autonomic nerve preservation and the preservation of both sphincter and urinary function with decreased postoperative pain,rapid recovery.