摘要
目的 探讨腹腔镜低位直肠癌经肛门根治切除套入式吻合保肛术的安全性、可行性以及临床疗效.方法 对23例低位直肠癌行腹腔镜下经肛门根治切除行套入式吻合保肛术.男11例,女12例.年龄36 ～ 78（平均59.8）岁.肿瘤距肛缘5～7 cm 20例,4cm3例,术前评估T1N0 M016例,T2N0 M07例.采用中间入路,用超声刀沿乙状结肠系膜根部游离并裸化肠系膜下动静脉根部后,将其施夹并切断.按TME原则,游离直肠至肛管直肠环达肿瘤远端3～5 cm,会阴部手术距齿状线上1 cm处环型切开,沿黏膜下锐性向上剥离至提肛肌平面切断直肠,将直肠及远端乙状结肠一并从肛门移出体外切除,行套入式近端结肠全层与直肠黏膜及肠黏膜下吻合.结果 23例手术平均时间为183 min,腹部手术时间约为132 min,经肛门套入式吻合手术时间为51 min;平均检出淋巴结13枚;术后发生吻合口瘘1例,行临时结肠造口3个月后还纳愈合.术后病理学检查：T1-2N0M0 14例,T2N1M09例.术后排便次数较多,术后6个月患者排便功能基本恢复正常,随访1～ 36个月,平均23个月,局部无肿瘤复发.结论 腹腔镜低位直肠癌根治经肛门切除标本,行套入式吻合保肛术,安全可行,且腹部无手术切口,达到完全微创、无瘢痕,有较好的临床效果.
Objectives To investigate the safety,feasibility and clinical outcome of laparoscopic anus-preserving anterior resection via telescopic colorectal mucosal anastomosis （TCMA） for low rectal cancer.Methods 23 patients with low rectal cancers,including 11 males and 12 females with an average age of 59.8 years underwent laparoscopic transabdominal and transanal anterior resection,followed by TCMA.The distance between the anus and inferior margin of the tumor ranged from 5 cm to 7 cm in 20 patients,and 4 cm in 3 patients.16 patients were on cT1N0M0 stage,7 on cT2N0M0 stage.Surgery was performed according to the TME principles,with dissection of mesocolon,high ligation of the inferior mesenteric artery and dissection to the levator ani.The rectum was mobilized 3-5 cm distal to the tumor to facilitate the perianal approach.A circumferential incision of the mucosa was made at 1 cm above the dentate line.Dissection was performed by mobilizing the rectum through the mucosal plane to approximately 2-4 cm and then the distal margin of the rectum was clamped and cut,with preservation of the entire muscular sheath of the rectum.The distal end of the colon was pulled through the anus,and TCMA of the sero muscular layer and muscular sheath was performed.Results The average operation time was 183 min.Average harvested lymph nodes was 13.Anastomotic leakage developed in one,cured by colostomy and subsequent closure.Pathology showed that 14 patients were of pT1-2N0M0 stage,9 on pT2N1M0.Continence was good when scored on 6 months after resection.Postoperative follow-up ranged from 1 to 36 months with a median time of 23 months,without local recurrence.Conclusions Laparoscopic anus-preserving rectectomy via TCMA for patients with low rectal cancer is safe,reliable and mini-invasive,with satisfactory mid term continence.
出处
《中华普通外科杂志》
CSCD
北大核心
2014年第8期623-625,共3页
Chinese Journal of General Surgery
关键词
直肠肿瘤
腹腔镜
直肠切除术
套入式结直肠吻合术
Rectal neoplasms
Laparoscopes
Anus-preserving rectectomy
Telescopic colorectal mucosal anastomosis
