腹腔镜直肠癌直肠全系膜切除保肛手术的临床应用

目的 探索腹腔镜下行直肠癌直肠全系膜切除（TME）保肛手术的可行性。方法 对2年余住院的54例直肠癌患者文施在腹腔镜下行TME保肛于术。54例中51例在腹腔镜下完成手术，包括前切除14例，低位前切除（吻合门距离齿状线2．0cm以上）19例，超低位前切除（吻合口与齿状线的距离小于2．0cm）16例，结肠-肛管吻合（吻合口位于齿状线）2例。3例中转开腹；其中2例因Dukes C期肿瘤已浸润肠管周围，1例因骨盆狭小，肿瘤距肛缘7cm．腹腔镜下操作困难而中转开腹。结果 51例腹腔下TME的患者手术顺利。手术时间110～210（平均145）min；术中出血30～80（平均50）mL；术后48～36h恢复胃肠功能并下床活动，住院时间7～14（平均9）d。术后应用止痛剂20例。术中术后均无并发症发生．术后控便功能的恢复旧吻合口高低而存在差异．6个月后均恢复正常排便功能。51例术后均随访，随访时间为6～36个月。均尤操作孔种植和肿瘤复发。结论 腹腔镜直肠癌TME保肛手术安全可行，其创伤小、出血少、术后恢复快，是极具应用前景的微创新技术。

The application of laparoscopic total mesorectal excision with preservation of anal sphincter for rectal cancer

Objective To explore the feasibility and efficacy of laparoscopic total mesorectal excision(TME) with preservation of anal sphincter for rectal cancer.Methods From October 2001 to March 2004,54(patients) with rectal cancer underwent laparoscopic total mesorectal excision(TME) with preservation of anal sphincter.In 51 of the 54 cases,the operation was completed laparoscopically,including 14 cases of(laparoscopic) anterior resection(AR) with the anastomosis level above the peritoneal reflection;20 cases of laparoscopic low anterior resection(LAR) with the anastomosis level more than 2cm above the dentate line;16 cases of laparoscopic ultralow anterior resection(ULAR) with the level of anastomosis within 2cm of the dentate line;and 2 cases of laparoscopic coloanal anastomosis(CAA) with the level of the anastomosis at or below the dentate line.whereas conversion to an open approach was required in three cases.Results The average operating time was 145 minutes(range 110~210min),and mean operative blood loss was 50 mL(range 30~80mL).Bowel function was restored and diet was resumed at 48 to 36 hours after operation.The average hospital stay was 9 days(range 7~14d).TME was completed successfully in 51 patients.Postoperative analgesics were used in 20 patients.No intraoperative or postoperative complications were(observed).Follow-up time was from 6~36 months in 51 patiebts,and there was no port-site or local tumor recurrence.Conclusions Laparoscopic TME is feasible and safe.It is a perspective technique with the(benefits) of minimally invasive technique and lower blood loss during operation,and rapid recovery.