54例腹腔镜直肠癌经腹超低位吻合治疗分析

  目的  探讨腹腔镜直肠癌经腹手术超低位吻合保肛的安全性和可行性。  方法  回顾性分析2014年7月至2017年6月西南医科大学附属医院收治的54例行腹腔镜直肠癌根治、超低位吻合患者的临床资料，观察并分析术后疗效。  结果  所有患者顺利完成手术，无中转开腹及手术死亡病例。平均手术时间（165±31）min，术中出血（12±5）mL。本组患者未常规进行预防性造瘘。术后发生吻合口出血2例（3.7%），吻合口漏3例（5.6%），均经保守治疗痊愈。术后患者排尿功能、性功能保持良好，术后一年时绝大部分患者肛门控制排便功能满意，术后随访两年以上均无局部复发，也无死亡病例，但手术一年后有3例患者出现肝脏转移。  结论  腹腔镜直肠癌经腹超低位吻合近期效果良好，远期效果有待进一步观察。 

Laparoscopic transabdominal ultra-low anastomosis for rectal cancer: experience of 54 cases

  Objectives  To evaluate the safety and feasibility of ultra-low anastomosis for anal preservation in laparoscopic rectal cancer surgery.  Methods  The clinical data of 54 patients with low rectal cancer admitted to The Affiliated Hospital of Southwest Medical University from July 2014 to June 2017 were retrospectively analyzed. The short-term effect and complications were analyzed.  Results  All patients underwent successful operations; conversion to laparotomy or death was not observed in any of the patients. The mean operative time was (165 ±31) minutes, and the intraoperative bleeding volume was (12 ±5) mL. There was no prophylactic ileostomy in all patients. Postoperative anastomotic bleeding and anastomotic leakage occurred in 2 and 3 cases, respectively; these complications were managed with conservative treatment. Postoperative urination and sexual functions of the patients remained good, and most patients were satisfied with their anal function 1 year post-operation. No local recurrences or deaths were noted after follow-up for more than 2 years. However, liver metastases were detected in 3 patients 1 year post-surgery.  Conclusions  Laparoscopic transabdominal ultra-low anastomosis for rectal cancer has a good short-term effect; however, the long-term effect remains to be evaluated.