经肛门拖出标本的全腹腔镜直肠癌全系膜切除术

目的探讨腹腔镜直肠癌全系膜切除术中切除标本自肛门内拖出的可行性。方法 2007年1月~2010年5月,对30例肿块5 cm的直肠癌施行全腹腔镜直肠癌全系膜切除术,手术标本自肛门拖出,肠断端腔镜下荷包缝合及管型吻合器结直肠吻合。结果 30例在腹腔镜下顺利完成手术,无中转开腹。无腹腔、盆腔脏器的损伤。手术时间120~240min,平均150 min;术中出血20~80 ml,平均35 ml。发生吻合口漏4例,均经保守治疗治愈(18~30 d)。术后随访3~40个月,平均24.3月,2例1年后吻合口复发。结论直径5 cm的标本自肛门拖出的全腹腔镜直肠癌全系膜切除术是可行的,避免腹部辅助切口,创伤更小。

Totally Laparoscopic TME and Transanal Extraction of Specimen for Rectal Cancer

Objective To explore the feasibility of transanal extraction in the laparoscopic total mesorectal excision（TME） for patients with rectal cancer.Methods From January 2007 to May 2010,clinical data of 30 patients with rectal cancer（tumor diameter 5 cm） were analyzed.Totally laparoscopic TME was performed with transanal extraction of the specimen.Purse-string suture and anastomosis by stapling were carried out afterwards. Results All the operations were finished successfully without conversion to open surgery.None of the patients had injuries to the abdominal and pelvic organs.The operation time ranged from 120 to 240 min with a mean of 150 min.The mean blood loss was 35 ml in this series（ranged 20 to 80 ml）.After the operations,four cases had anastomotic leakage,and then were cured by expectant treatment for 18-30 days.All of our patients were followed up for 3 to 40 months（mean,24.3 months）,during which there were 2 cases of local recurrence were found. Conclusions Totally laparoscopic TME with transanal extraction of the specimen（sized5 cm in diameter） is feasible for rectal cancer.The procedure results in a good cosmetic outcome by avoiding an abdominal auxiliary incision.