腹腔镜全直肠系膜切除保肛治疗直肠癌的手术技术探讨

目的探讨腹腔镜直肠癌全直肠系膜切除（Laparoseopie Total mesorectal excision，LTME）保肛术的可行性、安全性、操作要点及治疗效果。方法回顾分析51例腹腔镜直肠全系膜切除术患者的临床资料。结果51例患者手术顺利，无中转开腹，手术时间（128～280）min，平均143min；术中出血20～130ml，平均40ml；淋巴结清扫9～24枚，平均13．1枚。术后30～72h恢复胃肠功能并下床活动，住院时间5～16d，平均9d。51例术后随访1～36个月，平均17个月，均未发现吻合口肿瘤复发及远处转移。结论只要熟练地掌握腹腔镜下结肠、直肠毗邻结构的解剖，运用规范的操作和合理的手术技巧，腹腔镜直肠癌全直肠系膜切除保肛术安全可靠、创伤小、出血少、痛苦少、恢复快，是目前治疗直肠癌的一种较为理想的方法。

Investigation of operative technique of laparoscopic total mesorectal excision and anal sphincter preservation in the treatment for rectal cancer

Objective To explore the feasibility, safety, operating essentials and therapeutic effect of laparoseopic total mesorectal excision with anal sphincter preservation in the treatment of rectal cancer. Methods The clinical data of 51 cases with laparoscopic totalmesorectal excision were analyzed retrospectively. Results 51 cases were successfully completed and none of the patients were converted to open surgery. The operation time was 128 -280 min（ mean of 143 min）, and the intraoperative blood loss was 20 - 130 ml （ mean of 40 ml）. 9 -24 lymph nodes were resected（ mean of 13. 1 ）. The postoperative convalescence of intestinal peristalsis was 30 - 72 hours （ mean of 48 hours）. The postoperative hospital stay was 5 - 16 days, with an average of 9 days. All the secondary damages were managed successfully with laparoscopy. No complications of anastomotic leakage occurred after the operation. Conclusion Being familiar with the laparoscopic anatomy of the sigmoid colon and rectum, reasonable operational skills and standard manipulation are keys in preventing the secondary damage of Laparoscopic total mesoreetal excision and anal sphincter preservation in the treatment for rectal cancer, It has the advantage of safety, less trauma and hemorrhage, slight pain, rapid recovery, It is relatively safe and is a simple procedure and more ideal method for the treatment of rectal cancer.