腹腔镜改良Bacon术用于经肛全直肠系膜切除手术8例疗效分析

目的观察腹腔镜改良Bacon术在经肛全直肠系膜切除(TaTME)手术中的应用效果。方法回顾性分析2016年1月至2019年1月北京协和医院基本外科结直肠专业组收治的行TaTME的8例低位直肠癌病人的临床资料;术中均采用腹腔镜辅助改良Bacon结肠肛管吻合。术后观察吻合口漏等并发症的发生情况;并评估术后肛门功能。结果 8例病人均顺利实施手术。肿瘤下缘距肛缘距离为(4.8±0.4)cm。术后病理学检查获取淋巴结数目为(12.9±2.5)枚。一期手术时间为(140.8±8.6)min;二期手术时间为(39.1±9.6)min。两次手术间隔中位时间为19(13;20)d;中位住院时间为22(17;24)d。随访16(4;36)个月。8例病人术后均未出现吻合口漏。6例病人术后有肛门不自主排气;2例病人术后偶有黏液或稀水样便失禁表现;但均少于每个月1次;可通过饮食结构调节以及外用卫生护垫改善。结论腹腔镜改良Bacon术用于TaTME手术;避免了吻合口漏的发生;同时减少了术后肛门功能失禁的发生;但延长了住院时间。

Effect of modified laparoscopic Bacon coloanal anastomosis in transanal totalmesorectal excision:A 8 cases report

Effect of modified laparoscopic Bacon coloanal anastomosis in transanal totalmesorectal excision：A 8 cases report SUN Xi-yu，NIU Bei-zhan，ZHOU Jiao-lin，et al. Department of General Surgery，Peking Union Medical College Hospital，Chinese Academy of Medical Sciences，Peking Union Medical College，Beijing 100730，China
Corresponding author：QIU Hui-zhong，E-mail: qiuhzpumch@163.com
Abstract Objective To explore the effect of modified Bacon coloanal anastomosis in transanal total mesorectal excision（TaTME）. Methods The clinical data of 8 patients with low rectal cancer treated with TaTME from January 2016 to January 2019 in the division of colorectal surgery of department of general surgery of Peking Union Medical College Hospital were retrospectively analyzed. Laparoscopic assisted modified Bacon coloanal anastomosis was used during operation. The incidence of postoperative complications including anastomotic leakage was observed and the anal function was evaluated. Results All 8 patients underwent operation successfully. The distance from the inferior margin of the tumor to the anal verge was (4.8 ±0.4) cm. The number of retrieved lymph nodes in postoperative pathological examination was (12.9±2.5). The mean time of first operation was (140.8±8.6) min, and the Second stage operation time was (39.1±9.6) min. The median time between the two operations was 19 (13, 20) days, and the median hospital stay was 22 (17, 24) days. The median follow-up time was 16 (4, 36) months. No anastomotic leakage occurred and the anal function was good after operation. Six patients had uncontrollable anal exhaust after operation, and two patients had occasional mucous or watery fecal incontinence after operation, but they were less than once a month. They could be improved by dietary structure adjustment and external sanitary pads. Conclusion Laparoscopic-assisted modified Bacon operation in TaTME avoids anastomotic leakage, and reduces the incidence of anal incontinence after operation. However, the hospital stay is prolonged.