腹腔镜辅助括约肌间切除超低位直肠癌保肛手术的疗效研究

目的评价腹腔镜辅助括约肌间切除(ISR)超低位直肠癌保肛手术的可行性和安全性。方法回顾性分析2008年10月至2011年9月在我院实施的连续30例超低位直肠癌腹腔镜ISR手术的临床资料,与同期30例行开腹ISR手术患者进行比较,比较两组患者围手术期情况、肿瘤安全性、术后排便功能及近期疗效。结果腹腔镜组均行全直肠系膜切除(TME),且完全保留盆腔自主神经,没有中转开腹病例,中位手术时间213min,中位出血量80ml,术后中位住院时间14d,术后并发症9例(9/30),其中8例是肛周粪渍性湿疹,1例结肠黏膜脱出。与开腹手术组患者比较,腹腔镜手术组时间较短,出血量较少,住院时间较短,差异有统计学意义,并发症发生率无显著性差异。两组患者术后肛门排便功能以及直肠肛管测压结果无显著性差异。两组患者肿瘤安全性方面无显著性差异,中位随访时间17个月,两组均无局部复发、远处转移,全部患者无瘤生存。结论超低位直肠癌行腹腔镜ISR保肛手术技术上是可行的,短期疗效满意,是一种微创、安全的可供选择的保肛手术方法。

Evaluation of laparoscopic-assisted intersphincteric resection for ultralow rectal carcinoma

Objective To evaluate the safety and feasibility of laparoscopic intersphincteric resection ( ISR ) for ultralow rectal carcinoma. Methods From October 2008 to September 2011 , laparoscopic and open ISR were performed respectively in 30 patients with ultralow rectal carcinoma. Peri-operative parameters , oncologic safety, postoperative defecation functions , anorectal manometric results and short-term survival were compared between the two groups. Results No patient in laparoscopic group was converted to open surgery. The median operating time was 213min , median blood loss 80ml, median hospital stay 14 d , and postoperative complications occurred in 9 (9 / 30) patients including fecal eczema in 8 and colonic mucosa prolapse in one case in the laparoscopic group. Compared with the open group, the operating time and hospital stay were significantly shorter and blood loss was less in the laparoscopic group, but there were no significant differences in postoperative complications , defecation functions and anorectal manometric results and oncologic safety between the two groups. After the median follow up of 17 months, there was no local recurrence and distant metastasis in the two groups. Conclusion Laparoscopic-assisted ISR is a technically feasible and safe alternative to open surgery with better short-term postoperative outcomes for ultralow rectal carcinoma.