低位直肠癌腹腔镜辅助下经肛门拖出式吻合保肛术的临床研究

目的探讨腹腔镜经肛门拖出式吻合保肛术治疗低位直肠癌的可行性、安全性、根治性及近期临床疗效。方法回顾性分析我院2002年1月-2006年12月行低位直肠癌根治术65例的临床资料。其中，行腹腔镜低位直肠癌拖出式吻合保肛术28例（腹腔镜组），直肠癌低位前切除术37例（开腹组）。分析比较两组的手术方式、手术学指标、肿瘤学指标和近期疗效。结果腹腔镜组中转开腹1例。两组在手术时间、切除标本长度、清扫淋巴结数量、肠管远切缘长度方面无显著性差异（P〉0．05）。腹腔镜组术中平均出血量少、肠道功能恢复快，显著优于开腹组（P〈0．05）。两组平均随访35个月。腹腔镜组和开腹组术后并发症发生率分别为5．9％和6．5％；复发率和总生存率分别为3．6％、5．4%和96．4%、94．6％，均无显著性差异（P〉0．05）。结论腹腔镜经肛门拖出式吻合保肛术治疗低位直肠癌能够严格地遵守肿瘤学根治性原则，安全、可行，并具有出血少、住院时间短等优点。

Clinical study on laparoscopic transanal pull-through with anal sphincter preservation in the treatment of low rectal cancer

Objective To assess the feasibility,safety,radical cure and short-term outcome of laparoscopic transanal pull-through(LTPT)with anal sphincter preservation in comparison with open procedure for low rectal cancer.Methods From January 2002 to December 2006,28 patients undergoing a laparoscopic procedure for low rectal cancer(<7 cm from the anal verge)were subjected to LTPT with anal sphincter preservation,whereas 37 to 1ow anterior resection(LAR).The operative procedures,clinicopathological data and short-term outcomes were collected and compared.Results One case was converted to open surgery.No significant differences were observed between the two groups in terms of the operative time,resected specimen length,number of the resected lymph nodes and negative distal margin.The mean operative blood loss was less and the intestinal function was restored earlier in laparoscopic group(P<0.05).In laparoscopic group and LAR group,the incidence of postoperative complications was 5.9% and 6.5% respectively.Mean follow-up period was 35 months.The recurrent rate and overall survival rate were 3.6% and 96.4% in laparoscopic group,and those in LAR group were 5.4% and 94.6% respectively,with the difference being not significant(P>0.05).Conclusion LTPT with anal preservation can strictly follow oncologic principle,which is a safe and feasible approach to the surgical treatment of low/ultra-low rectal cancer,and has the benefits of much less blood during the operation and shorter hospital stay.