腹腔镜全直肠系膜切除术保肛治疗低位直肠癌.DOCVIP

临床医学论文-腹腔镜全直肠系膜切除术保肛治疗低位直肠癌 ??????????? 作者：伍溢文，张志勇，徐家朴，张建军，李慎惠，江尚回 【摘要】? 目的：探讨腹腔镜全直肠系膜切除术（total mesorectal excision,ＴＭＥ）行低位（超低位）直肠癌保肛治疗的方法与可行性。方法：按ＴＭＥ原则，用双吻合器技术在腹腔镜下对２６例低位（超低位）直肠癌患者实行ＴＭＥ低位（超低位）结肠直肠（肛管）吻合术。结果：手术均获成功，无中转开腹，手术时间１８０～２４０min，平均２１０min；术中出血３０～１００ml，平均７０ml；术后２d恢复胃肠功能并下床活动；住院７～１４d，平均８d，无严重并发症发生。结论：腹腔镜ＴＭＥ低位（超低位）吻合术保肛治疗低位直肠癌具有创伤小、并发症少、出血少、肠功能恢复快等优点，安全可行。 　　【关键词】? 直肠肿瘤；腹腔镜术；全直肠系膜切除术；保肛手术 　　Laparoscopic total mesorectal excision with anal sphincter preservation in the treatment of low rectal cancer 　　【Abstract】? Ｏbjective:To investigate the method and feasibility of laparoscopic total mesorectal excision(TME)with anal sphincter preservation in the treatment of low or ultralow rectal cancer.Methods:Excision of the mesorectum and low(ultralow)colorectal(anal) anastomosis were performed laparoscopically in 26 patients with low or ultralow rectal cancer based on the concept of TME and the double stapling technique(DST).Results:TME and DST were performed successfully in 26 patients through laparoscopy.The mean operative time was 210 min(180240 min)and the mean operative blood loss was 70ml(30100ml).The time for bowel function recovery was about two days.The average hospitalization was 8 days(714 days).Complications were not observed.Conclusions:Laparoscopic TME has some advantages in the treatment of low or ultralow rectal cancer，such as minimal invasive,less blood loss,low complication rate,and quick recovery. 　　【Key words】? Rectal neoplasms;Laparoscopy;Total mesorectal excision;Sphinctersaving procedure??? 　　直肠癌在消化道恶性肿瘤中发病率居第二位，低位直肠癌又占直肠癌的７５％。近２０年来全直肠系膜切除术（total mesorectal excision,ＴＭＥ）在临床上的成功应用，使低位直肠癌的保肛率明显提高，局部复发率下降。Hartley等［１］报道了用腹腔镜ＴＭＥ治疗直肠癌２１例。周总光等［２］亦报道了用腹腔镜ＴＭＥ保肛治疗低位直肠癌６２例。美国结直肠外科医师协会于２００４年发表了认可声明，有经验的外科医师行腹腔镜结直肠癌根治术可取得与开放手术相同的疗效［３］。２０００年３月至２００６年６月我院为２６例低位直肠癌患者行腹腔镜全直肠系膜切除术保肛治疗，其中５例行超低位保肛，取得了满意的临床效果，现报道如下。 　　1? 资料与方法 　　1.1? 临床资料? 本组２６例患者中男１７例，女９例，４７～７６岁，平均５２岁；肿瘤下缘距肛门缘５～８cm；Dukes分期：Ａ型８例，Ｂ型１２例，Ｃ型６例。患者术前病检均报告为直肠癌，病理类型中直肠高分化腺癌１９例，中分化腺癌７例；全组术前胸片、Ｂ超、ＣＴ等检查未发现远处转移，其中