低位直肠癌行腹腔镜会阴直肠切除术的应用

目的 探讨经腹腔镜会阴直肠切除术(laparoscopic rectoperineal resection, LAPR)治疗低位直肠癌的可行性.方法 对42例直肠癌患者经腹腔镜实施LAPR的临床资料进行回顾分析.结果 42例患者手术顺利.手术时间2～ 4.5 h,平均3.5 h;术中出血20～60 ml,平均40 ml;术后1～2 d恢复胃肠功能并下床活动;住院6～14 d,平均8 d.术后随访时间1～4年,术后因肝转移死亡1例,失访2例,有10例术后不足1年的患者,未发现转移及复发.结论 全直肠系膜切除 (total mesorectal excision, TME)是直肠癌根治切除术必须遵循的原则,经LAPR治疗低位直肠癌安全可行,且创伤小、术后疼痛轻、恢复快.

Application of laparoscopic rectoperineal resection to low rectal cancer

Objective To assess the feasibility of treating low rectal cancer with laparoscopic rectoperineal resection. Methods Forty-two cases of rectal cancer treated with laparoscopic total mesorectal excision were analyzed retrospectively. Results The operations in 42 cases were performed well. The duration of operations was 3.5 h (range 2-4.5 h). The amount of bleeding was 40 ml (range 20-60 ml). The gastrointestinal function recovered in 1-2 d after operation. The length of stay was 8 d (range 6-14 d). All patients had been followedup for 1-4 years after operation. One died of liver metastasis,and two missed. No metastasis and recurrence occurred in 10 patients in 1 year after operation. Conclusion Total mesorectal excision is the principle generally accepted in radical excision of rectal cancer. Laparoscopic rectoperineal resection for low rectal cancer is safe and feasible.