腹腔镜缝合术在直肠癌超低位吻合术中应用.docVIP

腹腔镜缝合术在直肠癌超低位吻合术中的应用 　　作者：王敬文,韩兴华,王建　　作者单位：潍坊市益都中心医院，山东 潍坊 　　【摘要】目的：探讨腹腔镜缝合术在直肠癌超低位保肛治疗术中的应用及可行性。方法：按全直肠系膜切除术(total mesorectal excision,TME)原则，用腹腔镜对30例超低位直肠癌患者行TME超低位结肠、直肠(肛管)吻合术，其中用双吻合器(DST)手术17例，手工缝合直肠远端加吻合器手术13例。结果：手术均获成功，无中转开腹。平均手术时间双吻合器组190min(170～250min)，缝合组270min(260～360min)。术中出血30～180ml，平均60ml;术后2d患者恢复胃肠功能并下床活动;平均住院11d(7～30d)。5例出现吻合口漏(DST组2例)，均保守治愈。结论：腹腔镜缝合术用于直肠癌超低位吻合术是可行的。 　　【关键词】 直肠肿瘤,腹腔镜术,全直肠系膜切除术;保肛手术 　　【Abstract】 Objective:To investigate the application and feasibility of suturing technique under laparoscopy with anal sphincter preservation in the treatment of ultra low rectal cancer.Methods:Excision of the mesorectum and ultra low colorectal(anal) anastomosis were performed by laparoscopy in 30 patients with ultra low rectal cancer based on the concept of TME，17 patients with the double stapling technique(DST) and 13 patients with laparoscopic suturing technique.Results:Operations were performed successfully in 30 patients through laparoscopy.The mean operative time was as follows:DST group 190min(170250min),suturing group 270min(260360min ).The mean blood loss was 60ml (30180ml).The time of bowel function recovery was about two days.The average hospitalization time was 11 days(730 days).5 cases occurred anastmotic leakage(DST group was 2),they were cured conservatiely.Conclusions:Laparoscopic suturing technique with anal sphincter preservation in the treatment of ultra low rectal cancer was feasibile. 　　【Key words】 Rectal neoplasms;Laparoscopy;Total mesorectal excision;Sphincter saving procedure 　　近20年来，随着全直肠系膜切除术(total mesorectal excision,TME)在临床上的成功应用，低位直肠癌的保肛率明显提高，局部复发率明显下降。特别是近些年来，腹腔镜结、直肠癌手术的广泛开展，使得超低位直肠癌保肛手术成为可能，并取得较好的临床效果。然而，腹腔镜直肠癌手术特别是低位保肛手术应用的切割闭合器(EndoGIA)，价格昂贵，明显限制了该类手术的普及。为此，我们尝试用腹腔镜缝合技术，替代EndoGIA，开展了超低位直肠吻合手术，取得了较好的临床效果，现报道如下。 　　1 资料与方法 　　1.1 临床资料 本组30例中男13例，女17例，40～78岁，平均56岁;肿瘤下缘距肛门缘4～5cm;Dukes分期：A期12例，B期16例，C期2例。患者术前病理均报告为直肠癌，病理类型中直肠高分化腺癌15例，中分化腺癌11例，直肠腺瘤恶变4例;肿瘤位于直肠后、侧壁24例，前壁6例;大小不超过直肠周径的1/2。全组患者术前胸片、B