腹腔镜下直肠旁肿物切除术（附8例报告）

目的探讨腹腔镜下直肠旁肿物切除术的安全性。方法 2005年10月~2010年6月,对8例CT或MRI检查明确诊断为直肠旁肿物施行腹腔镜下肿物切除术。经脐孔穿刺建立气腹,于骶骨岬水平打开后腹膜进入直肠旁间隙,腹腔镜下游离肿物并切除。结果 6例腹腔镜下完成手术,手术时间90～300 min,平均211.2 min;术中出血量20～200 ml,平均121.2 ml;盆腔引流管放置时间0～6 d,平均2 d;术后住院2～8 d,平均4 d;未发生肠管损伤、出血、盆腔内感染以及尿储留等并发症。2例因肿物与肛提肌及输尿管粘连而中转开腹。腹腔镜手术的6例随访12～58个月,中位时间17.5月,未见复发。结论直肠旁肿物可以在腹腔镜下切除,手术安全且损伤小。

Laparoscopic Resection of Retrorectal Tumors: Report of 8 Cases

Objective To evaluate the safety and advantage of laparoscopic resection for retrorectal tumors. MethodsMedical records of 8 patients with retrorectal tumors were reviewed retrospectively.The patients were diagnosed with MRI and received laparoscopic resection in our hospital from October 2005 to June 2010.During the operation,pneumoperitoneum was established with a 10-cm cannula through the inferior umbilical fold.At the level of the sacral promontory,the retroperitoneum was opened to expose the perirectal space so that to separate and remove the tumor. Results In the 8 cases,the procedure was completed under laparoscope in 6 patients within 90 to 300 minutes（mean,211.2 minutes）.During the operation,a mean of 121.2 ml blood loss was measured（20-200 ml）.After the procedure,pelvic cavity drainage was maintained for 0 to 6 days（mean,2 days）.The mean hospital stay of the patients was 4 days（2-8 days）.None of them had intestinal injury,hemorrhage,pelvic infection or urine retention.The other two cases were converted to open surgery because of adhesion between levator ani and ureter.The 6 patients who underwent laparoscopy were followed up for 12 to 58 months（median,17.5 months）,none of them showed recurrence. Conclusion Laparoscopic resection is safe and less traumatic for retrorectal tumors.