腹腔镜联合骶尾部切口在超低位直肠癌保肛术中的应用

2009年5月-2012年10月,对35例超低位直肠肿瘤经腹腔镜联合骶尾部入路行直肠癌根治术,肿瘤下极距肛门2.6-4.2 cm,平均3.9 cm,瘤体直径2.5-3.7 cm,平均3.2 cm.术中均未发生严重并发症和手术死亡,无中转开腹.手术时间120-220 min,平均185 min.术中出血40-110 ml,平均80 ml.术后肠蠕动恢复时间16-60 h,平均46 h.术后排便次数3-5次/d.无吻合口漏发生.骶尾部切口感染3例.术后病理TNM分期：Ⅰ期2例,ⅡA期9例,ⅡB期15例,Ⅲ期9例.病理类型：高分化腺瘤19例,中分化腺瘤12例,低分化腺瘤4例.下切缘镜下均为阴性,肿瘤距下切缘距离2-4.5 cm,平均3.9 cm.术后随访3-30个月,中位时间20.3月,无吻合口及盆腔复发,排便功能恢复均较满意.

The Value of Laparoscopy Combined with Sacral Coccygeal Approach in Sphincter-preserving Surgery for Ultra-low Rectal Carcinoma

The clinical data of 35 patients with ultra-low rectal cancer undergoing laparoscopy combined with sacral coccygeal approach from May 2009 to October 2012 in our hospital were retrospectively analyzed. The distance between the lower edge of the tumor and anus was 2.6-4.2 cm （mean, 3.9 cm） and the diameter of tumor was 2.5-3.7 cm （mean, 3.2 cm）. There were no serious intraoperative complications or mortality and no case was converted to open surgery. The operation time was 120 - 220 min （mean, 185 min） , blood loss was 40 - 110 ml （mean, 80 ml） , the time for gastrointestinal function recovery was 16 -60 h （mean, 46 h） and defecation frequency was 3 -5 times/d. No anastomotic leakage occurred and 3 cases suffered from incision infection. Postoperative pathological TNM stage：stage I in 2 cases, stage II A in 9 cases,stage 11 B in 15 cases,stage 11 in 9 cases. Pathologic type： 19 cases were highly differentiated adenoma, 12 cases were intermediately differentiated carcinomas, 4 cases were poorly differentiated carcinomas. All the incised edge of the specimens were negative under the microscope and the distance from tumor to incised edge was 2 - 4.5 cm （ mean, 3.9 cm）. All cases were followed up for 3 - 30 months, and the median follow-up time was 20.3 months. There was no anastigmatic recurrence and pelvic recurrence. Defecation function recovery was satisfying.