手助腹腔镜下直肠癌低位和超低位前切除术

目的总结手辅助腹腔镜（HALS）下低位和超低位直肠癌保肛手术的经验和近期疗效。方法回顾性分析2010年1月至2011年1月间在中山大学附属第一医院胃肠外科接受HALS下直肠前切除术的49例低位直肠癌患者的临床资料。结果49例直肠癌患者肿瘤近端切缘（14．3±6．9）cm,远切缘（4-3±1．9）cm,手术时间（128．3±70．9）min,术后肉眼评估全直肠系膜切除完整者42例。接近完整者为7例;环周切缘大于或等于2mm者为42例,小于2mm者为7例：获得R0切除者46例,R,切除者3例。淋巴结受检总数（16．2±9．2）枚／例,转移淋巴结（1．12±2．19）枚／例。术后病理示TNMI期12例,ⅡA期18例,ⅡB期1例,ⅢA期2例．HIB期8例,1IC期5例,Ⅳ期3例。术后住院时间（6．3±3．9）d,未见吻合口瘘、肠梗阻、腹、盆腔及吻合口出血,术后切口感染2例。结论HALS下直肠癌低位和超低位前切除术安全、可行,近期效果良好。

Low and ultralow anterior resection with hand-assisted laparoscopic surgery for rectal cancer

Objective To summarize the experience and short-term clinical outcomes of hand- assisted laparoscopic surgery （HALS） in sphincter-preserving surgery for low and ultralow rectal cancer. Methods Data of 49 patients with rectal cancer who underwent HALS for low or ultralow anterior resection between January 2010 and January 2011 were analyzed retrospectively. Results The proximal resection margin was （14.3_＋6.9） cm and the distal margin was（4.3＋l.9） cm. The mean operaitve time was （128.3_＋70.9） rain. On postoperative macroscopic evaluation, the mesorectum was intact in 42 cases, nearly intact in 7 cases. The circumferential resection margin was more than 2 mm in 42 cases, and less than 2 mm in 7 cases. Forty-six patients underwent R0 resection, and 3 cases underwent R1 resection. The median retrieved lymph node （LN） was 16.20_＋9.23, and the median positive LN was 1.12_＋2.19. Postoperative pathological examination showed TNM stage was I in 12 patients, 11 A in 18, IIB in 1, IIIA in 2, III B in 8, m c in 5, 1V in 3. The median postoperative hospital stay was （6.25 _＋3.87） d. There were no anastomotic leakage, ileus, intra-abdominal or anastomotic bleeding. There were two wound infections. Conclusion Low and uhralow anterior resection for rectal cancer using HALS approach is safe and feasible with favorable short-term outcome.