腹腔镜低位直肠癌经肛拖出切除吻合术的临床应用

目的 探讨腹腔镜低位直肠癌经肛拖出切除吻合术的临床应用价值.方法 2009年6月～ 2011年9月,对45例低位直肠癌行腹腔镜经肛拖出切除吻合术,均行腹腔镜下全直肠系膜切除,并行预防性回肠造瘘.结果 45例均完成手术,无中转开腹,切割圈均完整,无输尿管损伤.手术时间185 ～ 260 min,平均215 min,术中出血量50 ～250 ml,平均110ml.切除淋巴结15 ～ 20枚,平均16.5枚,术后病理9例有阳性淋巴结.术后回肠造瘘排气时间3～5d,平均3.5d,留置导尿3～4d.术后无切口感染、肠粘连、切口裂开,术后住院时间12～ 17 d,平均15 d.随访15～28个月,平均23个月,未发现局部复发及远处转移.回肠造瘘回纳后,肛门控便、控气功能良好.结论 腹腔镜低位直肠癌经肛拖出切除吻合术安全可行,为瘤体较小、组织学分型好的早、中期的低位直肠癌提供一种较好的术式选择.

Clinical Application of Laparoscopic Transanal Pull-through Resection and Anastomosis for Low Rectal Cancer

Objective To evaluate the clinical value of laparoscopic transanal pull-through resection and anastomosis for the treatment of low rectal cancer. Methods From June 2009 to September 2011, 45 patients with low rectal carcinoma underwent laparoscopic transanal pull-through resection and anastomosis. All the patients received laparoscopic total mesorectal excision and prophylactic ileostomy. Results All the operations were completed successfully without conversion to open surgery, fragmentary cutting ring, or ureteral injury. The mean operation time was 215 min （185 -260 min） , and the mean intraoperative blood loss was 110 ml （50 -250 ml）. The mean number of lymph node excised was 16.5 （15 -20）. 9 cases have positive lymph nodes. The mean time for gastrointestinal function recovery and indwelling catheter was 3.5 d （3 - 5 d） and 3.7 d （3 - 4 d）. Postoperative hospital stay was 12 to 17 d, with an average of 15 d. No incision infection, anastomotic leakage or intestinal adhesion was observed. All of the patients were followed up for 15 to 28 months （mean, 23 months）. No local relapse or distal metastasis was observed. All the cases had no anal incontinence after stoma closure operation. Conclusions Laparoscopic transanal pull-through resection and anastomosis is an effective, simple and safe procedure. It is a good alternative for the treatment of early or middle clinical stage low rectal cancer of favorable histological types and relatively smaller size.