摘要
目的:探讨腹腔镜辅助低位直肠癌改良Bacon术的安全性和可行性。方法:回顾性分析2018年10月至2021年05月河南大学淮河医院肛肠外科收治的26例低位直肠癌患者的临床资料,患者均行腹腔镜辅助改良Bacon术。按照全直肠系膜切除(TME)原则充分游离直肠及其系膜,至肛提肌平面,会阴组医师牵开肛门,直视下在肿瘤下缘缝合黏膜层,逐层分离至与腹腔组贯通,拉出切除标本,肛门外留取肠管3~5 cm,将乙状结肠浆膜与直肠残端黏膜缝合固定。术后3周行外置肠管切除肛门成形术。术后Wexner评分量表评估患者的肛门功能。结果:26例患者中,男性16例,女性10例,年龄40~72(中位56)岁,体质量指数20.4~33.5(中位26.5) kg/m^(2),肿瘤距离肛缘3~6 cm;术前盆腔磁共振T分期T1期2例,T2期20例,T3期4例。全组患者手术均顺利完成,无一例中转开腹,手术时间124~182 min;术中出血量10~50(中位20) mL。术后病理分期Ⅰ期2例,Ⅱ期22例,Ⅲ期2例。术后患者排气时间24~128h,首次手术住院时间4~15d。1例患者术后出现外置肠管坏死合并腹腔感染,二次手术末端回肠造瘘后恢复顺利。术后1 mon的肛门功能Wexner评分与术前相比差异均无统计学意义(P>0.05);术后26例患者随访2~31 mon未见局部复发或远处转移。结论:改良Bacon术可以有效避免吻合口漏风险,并不影响术后的肛门功能,是安全可行的。
Objective: Investigate the feasibility and application value of Delayed Colo-anal anastomosis for low rectal cancer. Methods: A retrospective analysis of the data of 26 patients with low rectal cancer admitted to the Department of Anorectal Surgery, Huaihe Hospital of Henan University from October 2018 to May 2021, all patients underwent Delayed Colo-anal anastomosis surgery following the principles of TME. Fully free the rectum and its mesentum to the level of the levator ani muscle. Under direct vision, the mucosal layer was sutured on the lower edge of the tumor, separated layer by layer to penetrate the abdominal cavity group, and the excision specimen was pulled out, and the intestinal tube 3~5 cm was left outside the anus, and the sigmoid colon serous membrane and the rectal stump mucosa were sutured and fixed. Anastomosis was performed 3 weeks after the operation. Wexner scale was used to evaluate the postoperative anal function of patients. Results: There were 16 males and 10 females, aged 40~72 years old, body mass index 20.4~33.5(median 26.5) kg/m^(2), tumor distance 3~6 cm from the anal margin;preoperative pelvic magnetic resonance T stage T1 stage 2 cases, 20 cases in T2 stage, 4 cases in T3 stage. Therefore, the operation of the patients was successfully completed. The operation time was 124~182 min;the intraoperative blood loss was 10~50(median 20) mL. Postoperative pathological staging was performed in 2 cases in stage Ⅰ, 22 cases in stage Ⅱ, and 2 cases in stage Ⅲ. The postoperative exhaust time was 24 to 128 h, and the hospital stay for the first operation was 4 to 15 d. One patient developed external intestinal necrosis and abdominal infection after surgery, and recovered smoothly after a second operation with terminal ileostomy. There was no significant difference in the Wexner score of anal function at 1 month after operation compared with that before operation(P>0.05);There were no local recurrence or distant metastasis in 26 patients following up for 2~31 months after operation. Conclusion: Delayed Colo-anal anastomosis surgery can effectively avoid the risk of anastomotic leakage and does not affect postoperative anal function. It is safe and feasible.
作者
王晨宇
李兴旺
吴航
张军杰
葛政
胡军红
WANG Chenyu;LI Xingwang;WU Hang;ZHANG Junjie;GE Zheng;HU Junhong(Department of Anorectal Surgery,Huaihe Hospital of Henan University,Kaifeng 475000,CHN;Department of Colorectal and Anal Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,CHN)
出处
《河南大学学报（医学版）》
CAS
2023年第1期49-53,共5页
Journal of Henan University:Medical Science
基金
吴阶平医学基金会临床科研专项资助基金(320.2710.1836)
河南省科技攻关计划(202102310094)
关键词
直肠癌
BACON
经自然腔道取标本手术
腹腔镜
肛门功能
rectal cancer
laparoscopy
Delayed Colo-anal anastomosis
natural orifice specimen extraction surgery
anal function
