摘要
目的探讨盆膈上筋膜作为腹腔镜中低位直肠癌括约肌间切除(ISR)术中解剖定位标志的临床效果。方法回顾性分析2018年10月至2020年5月在吉林大学中日联谊医院胃肠结直肠肛门外科行腹腔镜ISR的21例中低位直肠癌患者的临床资料,包括术前一般情况、术中术后相关数据以及相应的手术录像资料,探讨盆膈上筋膜在中低位直肠癌ISR中的定位作用。结果21例患者术中经肛操作部分以盆膈上筋膜作为指引,均遵循全直肠系膜切除原则顺利完成手术,无中转开腹病例,平均手术时间(242.9±66.4)min,术中出血量30.5(23.6,65.5)mL,淋巴结检出数目(15.1±1.9)枚,肿瘤下缘距远切缘距离为(2.9±1.4)cm,全部患者手术标本切缘均为阴性、系膜完整。术中1例(4.8%)患者出现输尿管损伤,1例(4.8%)患者出现阴道损伤;术后1周2例(9.5%)患者出现吻合口漏,积极保守治疗后好转,顺利出院。所有患者术后随访7~30个月,中位随访时间23个月,有2例(9.5%)患者复发,其余19例(90.5%)患者未诉明显不适。未行预防性回肠造口患者术后6个月仅1例患者出现轻度LARS,行预防性回肠造口患者造口还纳术后6个月均无LARS。结论在中低位直肠癌腹腔镜ISR手术中,准确辨识盆膈上筋膜有利于指引术中操作在正确的解剖层面进行,保障手术效果,且患者术后肛门功能良好。
Objectives To investigate the clinical effect of using the superior fascia of the pelvic diaphragm as anatomic landmark in laparoscopic intersphincteric resection(ISR)for mid-and low rectal cancer.Methods This was a retrospective analysis of 21 patients with mid-and low rectal cancer treated at the Department of Gastrointestinal,Colorectal,and Anal Surgery,China-Japan Union Hospital of Jilin University,between October 2018 and May 2020.To investigate the effect of using the superior fascia of the pelvic diaphragm as anatomic landmark ISR for mid-and low rectal cancer,we analyzed patients’characteristics,perioperative parameters,and video recording of the surgery.Results For all 21 patients,the trans-anal procedures used the superior fascia of the pelvic diaphragm as landmark and followed the principle of total mesorectal excision.All surgeries were uneventful,and there were no conversions to open surgery.The mean±SD duration of surgery was(242.9±66.4)minutes,intraoperative blood loss was 30.5(23.6,65.5)mL,lymph node yield was(15.1±1.9),and the distance between the distal margin of the tumor to resection margin was(2.9±1.4)cm.All resection margins were negative,and the membrane was complete.One(4.8%)patient experienced ureteral injury,and one(4.8%)experienced vaginal injury.Two(9.5%)patients experienced anastomotic leakage one week after surgery,and the patients’situation improved after treatment.All patients were followed up from 7 to 30 months,with a median of 23 months.Two(9.5%)patients had recurrence,and the remaining 19(90.5%)patients had no major discomfort complaints.In the patients who did not have prophylactic ileostomy,only one patient had low anterior resection syndrome(LARS)at six months postoperatively.No patients who had prophylactic ileostomy experienced LARS at six months after ileostomy reversal.Conclusion In patients with mid-and low rectal cancer who underwent laparoscopic ISR,accurate identification of the superior fascia of the pelvic diaphragm can correctly guide the operation in the correct anatomical layer.It ensures the effectiveness of the surgery and is associated with good postoperative anal function.
作者
李瑞奇
沈可欣
王泽铭
谢忠士
Li Ruiqi;Shen Kexin;Wang Zeming;Xie Zhongshi(Department of Gastrointestinal,Colorectal,and Anal Surgery,China-Japan Union Hospital of Jilin University,Changchun 130031,Jilin,China)
出处
《结直肠肛门外科》
2021年第3期221-224,共4页
Journal of Colorectal & Anal Surgery
基金
吉林省省直厅局项目(3D5198171430,3D518U773430)。
关键词
中低位直肠癌
括约肌间切除术
盆膈上筋膜
mid-and low rectal cancer
intersphincteric resection
superior fascia of the pelvic diaphragm
