完全经肛全直肠系膜切除术联合括约肌间切除治疗超低位直肠癌.docVIP

完全经肛全直肠系膜切除术联合括约肌间切除治疗超低位直肠癌 姚宏伟 陈宁 张志鹏 张忠涛 首都医科大学附属北京友谊医院普通外科肿瘤侵袭和转移机制研究北京市重点实验室国家消化系统疾病临床医学研究中心 北京大学第三医院普通外科 X 关注成功！ 加关注后您将方便地在 我的关注中得到本文献的被引频次变化的通知！ 新浪微博 腾讯微博 人人网 开心网 豆瓣网 网易微博 摘????要： 目的 探索应用完全经肛全直肠系膜切除 (pure transanal total mesorectal excision, pure-TaTME) 联合括约肌间切除 (intersphincteric resection, ISR) 治疗超低位直肠癌术式的安全性及可行性。方法 经过术前肠镜、直肠腔内超声及盆腔磁共振 (magnetic resonance imaging, MRI) 等检查进行评估, 筛选出本例超低位直肠癌患者, 顺利施行pure-TaTME联合ISR手术:利用肛门牵开器充分显露肛管, 直视下完成ISR手术。然后建立经肛手术路径, 完全经肛完成pure-TaTME手术, 并创建肠道的连续性。结果 手术时间350 min, 术中出血量200 mL。切除标本长约18 cm, 远断端切缘1.0 cm, 直肠系膜完整。术后病理报告为直肠高级别锯齿状腺瘤, 局灶黏膜内癌变, 远近断端及环周切缘阴性;检出淋巴结32枚, 未见癌转移。病理分期为p T1N0M0。患者术后恢复满意, 术后3d肠道功能恢复, 开始进流食, 术后第5天进半流食, 无感染及吻合口瘘发生。至今随访24个月, 大便控制功能良好, 未见肿瘤复发转移。结论 完全经肛全直肠系膜切除 (pure-TaTME) 联合括约肌间切除 (ISR) 治疗超低位直肠癌安全可行, 这为低位甚至超低位直肠癌的外科治疗提供了一种可行性选择, 但远期效果还需要更多病例进行临床研究来确定。 关键词： 超低位直肠癌; 经肛全直肠系膜切除术; 完全经肛全直肠系膜切除术; 括约肌间切除术; 作者简介：Zhang Zhongtao, E-mail:zhangzht@ 收稿日期：2017-10-16 基金：国家科技支撑计划课题 (2015BAI13B09) Transanal total mesorectal excision combined with intersphincteric resection for ultra-low rectal cancer Yao Hongwei Chen Ning Zhang Zhipeng Zhang Zhongtao Department of General Surgery, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University; Department of General Surgery, Peking University Third Hospital; Abstract： Objective To explore the safety and feasibility of pure transanal total mesorectal excision (pure-TaTME) combination with intersphincteric resection (ISR) for ultra-low rectal cancer.Methods The patient with ultra-low rectal cancer, who had been treated with pure-TaTME and ISR, was screened carefully by colonoscopy, endorectal ultrasound and MRI examination.A purse suture closure of the rectal lumen at the level of tumors inferior edge was done transanally.The cut-line was made vertically to the anal canal at the level of dentate line, and further ISR procedure was performed upright i