腹腔镜下全直肠系膜加经内外括约肌间切除用于超低位直肠癌保肛手术.DOCVIP

临床医学论文-腹腔镜下全直肠系膜加经内外括约肌间切除用于超低位直肠癌保肛手术 ?????????? 作者：李敏哲，杜燕夫，王振军，韩进，渠浩 【摘要】? 目的：探讨腹腔镜下全直肠系膜加经内外括约肌间切除术治疗超低位直肠癌的可行性及优势。方法：回顾分析2004年11月至2005年11月7例腹腔镜下全直肠系膜加经内外括约肌间切除治疗超低位直肠癌的临床资料。结果：本组7例术中出血量30~80ml，手术时间3.5~5h，无术中死亡病例，术后持续胃肠减压24h，术后24~48h开始饮食，术后3d拔除尿管下床活动，术后1~2d开始排便。术后住院7~10d。随访3~6个月，无局部复发。结论：腹腔镜下按全直肠系膜切除术（TME）要求游离直肠至盆底耻骨直肠肌水平，经肛门于齿状线水平切断直肠，再经肛门手工行结肠-肛管吻合的方法治疗超低位直肠癌，能够保证完整切除直肠系膜，术中减少出血，住院天数缩短，在降低手术难度、提高保肛率等方面有其优势。患者对本术式的耐受性较好。 　　【关键词】? 直肠肿瘤；全直肠系膜切除术；经内外括约肌间切除；保肛手术；腹腔镜 　　A sphinctersaving procedure by laparoscopic assisted total mesorectal excision plus intersphincteric resection in the treatment of ultralow rectal cancer 　　【Abstract】? Ｏbjective:To estimate the feasibility and advantages of laparoscopic assisted total mesorectal excision(TME)plus intersphincteric resection(ISR) in treatment of ultralow rectal cancer.Methods:The clinical data of 7 patients with ultralow rectal cancer received laparoscopic assisted TME plus ISR from November 2004 to November 2005 was retrospectively analyzed.Results:The operation time was 3.55 hours and the intraoperative bleeding was 3080ml.No intraoperative death occurred.The nasogastric tube was removed after 24 hours and the time of drinking water was 2448 hours after operation.The time of pulling out urinepipe and returned bowel function were 3 days and 12 days after operation respectively.The hospitalization was 710 days.No local recurrence was found after 36 months followup.Conclusions:Laparoscopic assisted TME and colonanal anastomosis through anus for superlow rectal cancer is feasible and have advantages of TME,less bleeding,quick recovery and fine sphincter preservation. 　　【Key words】? Rectal neoplasms;Total mesorectal excision;Intersphincter resection;Sphinctersaving procedure;Laparoscopy ??? 自1982年Ｈeald［１］提出全直肠系膜切除（total mesorectal excision,TME)的概念后，TME已被广泛用于直肠癌的治疗，并取得了较好的疗效。随着腹腔镜技术的发展，腹腔镜下ＴＭＥ手术日臻成熟，腹腔镜技术在低位及超低位直肠癌治疗中的应用，体现了其特有的自由观察角度的优势。2004年１１月至２００５年１１月我院采用腹腔镜下TME加经内外括约肌间切除的方法为７例超低位直肠癌施行了保肛手术治疗。现就其适应证、操作要点及可行性进行讨论，并报道如下。