完全腹腔镜超低位直肠癌手术技巧.pdfVIP

完全腹腔镜超低位直肠癌手术技巧 陈德兴朱安东刘奇 (吉林省微创外科研究所长春130012) 【摘要l目的探讨腹腔镜超低位直肠癌手术的可行性及手术技巧。方法按全直肠系膜切除原则行腹腔镜超低位直肠癌 前切除术16例，先游离乙状结肠及降结肠至结肠脾曲，将肠系膜下动脉离断，游离直肠至肛提肌水平，于距肿瘤下缘3．0 伽处离断直肠，拉出腹腔，切除肿瘤肠管，置入吻合器抵钉座，还纳回腹，自肛门插入吻合器，与抵钉座相接，行直肠乙状 结肠吻合。结果16例手术均获成功，残端闭合满意，术中快速冰冻切片检查未见肿瘤残留，术后无吻合tZl瘘发生。术后半 月内均行规范化疗6个疗程，术后l例失访，余15例随访13．60个月，l例2年后因心肌梗死死亡，14例健在。结论腹腔 镜超低位直肠癌手术具有创伤小，恢复快，术后住院时间短，直视下分离直肠安全、可靠、出血少，可以在临床上广泛开 展。 I关键词】腹腔镜手术直肠癌 The lowrectalcancer clinical appficafionsoftotallylaparoscopie surgeryCHENDe-xing,ZHUAn-dong，LIUQi(Department Weis ofGeneralSurgery,QianHospitalofJilinprovince，Changchun130012，Jilm，China) To and resection cancer． the ofultra-lowrectal 【Abstract】objectiveexplorefeasibilitySurgicaltechniqueofLaparoscopic tO rectal was 16 Method the ofTME ultra-low resectionof cancer in Accordingprinciples laparoscopicLaparoscopic applied colonthe theinferior cases．Thefirstdissociate colonand to flexure，transect descending sigmoid splenic mesenteric甜teq， tllerectumtotheleveloflevator fromthetunlorinferiorborder3．0em．therectumwastransected．Then dissociate ani．Away pull theabdominal bowelWas arrivedtonailsintoblocksandrectunlwasreturnedtothe awayfrom cavity,diseasedresected．Stapler abdomen．Insertthe fromme colonallrectalwereanastomosiscd．Results16caseswere stapler anus。andsigmoid successful， section no satisfiedwith frozen tumorresidedand occurred stump