腹腔镜下直肠癌全直肠系膜切除术

目的 探讨腹腔镜下行直肠癌全直肠系膜切除根治术的临床效果。方法 对38例直肠腺癌患者采用腹腔镜下联合应用超声刀循盆筋膜壁层和脏层的间隙行锐性游离全直肠系膜,切除一个不间断的直肠整体标本,并对全组病例随访2年余。结果 38例患者手术顺利,无中转开腹,术后排便、排气时间平均为32h,术后平均住院天数为7．5d。术后随访至今,38例患者均无腹部穿刺口种植,其中2例出现局部复发(1例伴肝转移)。38例患者均无排尿困难,6例患者有性功能减退。结论 腹腔镜下行直肠癌全直肠系膜切除术手术既能有效降低术后局部复发率和保护盆腔自主神经功能,又具有微创优点,值得临床推广。

Radical resection with total mesorectal excision under the laparoscope in the treatment of rectal cancer

Objective To evaluate the effect of radical resection with total mesorectal excision under the laparoscope in the treatment of rectal cancer. Methods Under the laparoscope and with the ultrasonic scalpal , total mesorectal excision in 38 patients with rectal cancer was performed.In operation,alone the parietal layer of pelvic fascia and inside the autonomic nerve trunk,the mesorectum was excised. All patients were follwed up for 2 years. Results All cases were underwent successfully and no complication was observed. Postoperational flatus and feces were passed at 32 hours and postoperational hospital stay were 7.5 days. No trocar port implantation and no death case was observed. Two local recurrence developed in 2 years follow up. Conclusions Radical resection with TME is a new progress of less damageable operation,which has advantages of low postoperative local recurrence rate and help for pelvic autonomic nerve.