腹腔镜全直肠系膜切除保肛治疗直肠癌临床应用.docVIP

腹腔镜全直肠系膜切除保肛治疗直肠癌临床应用[摘要] 目的：探讨腹腔镜直肠癌全直肠系膜切除（laparoscopic total mesorectal excision，LTME）保肛术的可行性、安全性、操作要点及治疗效果。方法：回顾分析39例腹腔镜直肠全系膜切除术患者的临床资料。结果：39例患者手术顺利，无中转开腹，手术时间为140～280 min，平均150 min；术中出血20～130 ml，平均40 ml；淋巴结清扫4～23枚，平均10.3枚。术后30～72 h恢复胃肠功能并下床活动，住院时间5～16 d，平均9 d。39例术后随访2～36个月，平均18个月，均未发现吻合口肿瘤复发及远处转移。结论：腹腔镜全直肠系膜切除保肛治疗直肠癌，除具有创伤小、出血少、保肛率高、术后疼痛轻、恢复快等优点外，对自主神经丛的保护更准确，术后肛门括约肌功能及排尿功能良好，是一项微创治疗直肠癌的技术。 [关键词] 直肠肿瘤；腹腔镜；全直肠系膜切除术；保肛术 [中图分类号] R735.3+7 [文献标识码]A[文章编号]1674-4721（2011）08（b）-054-03 Clinical application of laparoscopic total mesorectal excision and anal sphincter preservation in the treatment for rectal cancer ZHENG Zheng1, NIE Wanpin2 1.Hunan Province Chest Hospital, Hunan Province, Changsha 410081, China; 2.Third Xiangya Hospital of Central South University, Hunan Province, Changsha 410013, China [Abstract] Objective: To explore the feasibility, safety, operating essentials and therapeutic effect of laparoscopic total mesorectal excision with anal sphincter preservation in the treatment for rectal cancer. Methods: The clinical data of 39 cases with laparoscopic totalmesorectal excision were analyzed retrospectively. Results: 39 cases were successfully completed and none of the patients were converted to open surgery. The operation time was 140-280 min, the average of 150 min, and the intraoperative blood loss was 20-120 ml, the average of 40 ml. 4-23 lymph nodes were resected, the average of 10.3 lymph. The postoperative convalescence of intestinal peristalsis was 30-72 hours, the average of 48 hours. The postoperative hospital stay was 5-16 days, with an average of 9 days. All the secondary damages were managed successfully with laparoscopy. No complications of anastomotic leakage occurred after the operation. Conclusion: Laparoscopic total mesorectal excision and anal sphincter preservation in the treatment for rectal cancer is a perspective minimally invasive technique, which is feasible, safe and effective. With the use of this technique, surge