腹腔镜全直肠系膜切除术保肛治疗低位直肠癌

目的:探讨腹腔镜全直肠系膜切除术(total mesorectal excision,TME)行低位(超低位)直肠癌保肛治疗的方法与可行性。方法:按TME原则,用双吻合器技术在腹腔镜下对26例低位(超低位)直肠癌患者实行TME低位(超低位)结肠-直肠(肛管)吻合术。结果:手术均获成功,无中转开腹,手术时间180-240min,平均210min;术中出血30-100ml,平均70ml;术后2d恢复胃肠功能并下床活动;住院7-14d,平均8d,无严重并发症发生。结论:腹腔镜TME低位(超低位)吻合术保肛治疗低位直肠癌具有创伤小、并发症少、出血少、肠功能恢复快等优点,安全可行。     

腹腔镜全直肠系膜切除保肛治疗低位直肠癌(附42例报告)

目的　探讨腹腔镜下完成全直肠系膜切除 (TME)、低位 /超低位 /行结肠 -肛管吻合治疗低位直肠癌的可行性。　方法　按TME原则 ,在腹腔镜下对 4 2例低位直肠癌患者实施低位 /超低位 /结-肛吻合术。　结果　 4 2例腹腔镜TME、低位 /超低位 /结肠 -肛管吻合术均获成功 ,保肛率 10 0 %。手术时间 (110～ 2 10 )分钟 ,平均 12 5分钟 ;术中出血 (5～ 80 )ml,平均 2 0ml;术后 1～ 2天恢复胃肠功能并下床活动 ,住院时间 (5～ 14 )天 ,平均 8天。术后 18例应用了止痛剂 ,术中及术后均无并发症发生。　结论　腹腔镜下行TME低位 /超低位结肠 -肛管吻合术治疗低位直肠癌可行。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、排尿功能良好     

腹腔镜全直肠系膜切除保肛治疗低位直肠癌

目的：探索腹腔镜全直肠系膜切除（TME）低位、超低位前切除治疗低位直肠癌的可行性。方法：按TME原则、用双钉合技术（DST）,在腹腔镜下对62例低位直肠癌患者实施TME、DST低位、超低位结肠-肛肠吻合术。结果：手术时间11-210min,平均125min;术中出血5-80ml,平均20ml;术后1-2d恢复胃肠功能并下床活动,住院时间5-14d,平均8d。1例患者因凝血障碍中转开腹,其他61例患者手术顺利。术后疼痛剂应用28例,除1例吻合口漏、1例尿潴留外,其余患者未见术中及术后并发症。结论：腹腔镜TME、低位、超低位吻合术治疗低位直肠癌,创伤小、保肛率高、术后疼痛轻、恢复快,是极具应用前景的微创新技术。     

腹腔镜全直肠系膜切除联合经肛内括约肌切除保肛术治疗超低位直肠癌

目的探讨腹腔镜全直肠系膜切除（total mesorectal excision,TME）联合经肛内括约肌切除（intersphinctericresection,ISR）保肛术治疗超低位直肠癌的可行性及疗效。方法 2006年5月~2009年5月,18例超低位直肠癌（肿瘤直径0.8~5.5 cm,下缘距肛缘1.9~4.5 cm）行腹腔镜TME联合ISR术。病例选择标准：肿瘤下缘距肛门〈5 cm;直肠指诊肿块可以推动;腔内B超、MRI或CT提示无外括约肌受累;无远处转移;肛门括约肌功能正常。腹部：在腹腔镜下TME法分离直肠及其系膜至肛提肌水平。肛门部：切开肛管黏膜至内外括约肌间隙,沿间隙向盆腔分离,与腹部操作部位会合,移除标本,结肠肛管吻合。术后进行随访。结果 18例均在腹腔镜下顺利完成手术,无围手术期死亡。手术时间180~300 min,平均220 min。术中出血40~160 ml,平均100 ml。手术切缘均阴性。10例未行回肠造口者中发生吻合口漏3例,加行回肠造口术及充分引流后痊愈。全组随访12~46个月,平均23个月。术后早期肛门经常粪污,每日排便3~10次。术后1年排便次数减为每日1~4次,控便时间可达5 min以上。根据Kirwan分级,1年后肛门功能Ⅰ级＋Ⅱ级16例,Ⅲ级2例。结论选择合适的超低位直肠癌,特别是没有侵犯外括约肌的早期患者,采用腹腔镜TME联合经肛内括约肌切除保肛术是可行的,能体现根治、保肛、微创和经济的优点。     

腹腔镜全直肠系膜切除治疗中低位直肠癌67例

目的探讨腹腔镜全直肠系膜切除(TME)治疗中低位直肠癌的可行性。方法回顾性分析2003年7月至2005年12月间对67例中低位直肠癌患者进行腹腔镜TME手术治疗的临床资料。结果67例患者顺利完成腹腔镜TME手术,无中转开腹。手术时间(140.5±22.4)min,术中出血量(60±28)ml,手术并发症13.4%。总保肛率为73.1%,超低位直肠癌患者保肛率为61.7%。术后(2.0±1.5)d胃肠功能恢复,术后住院时间(12.1±5.2)d。88%患者获得5-34个月的随访,未见戳孔种植发生。结论腹腔镜TME手术治疗中低位直肠癌具有手术创伤小、术中出血少、术后疼痛轻、胃肠功能恢复快、保肛率高的优点。     

低位直肠癌腹腔镜下全直肠系膜切除保肛术的临床效果分析

为探讨腹腔镜下全直肠系膜切除保肛手术在低位直肠癌治疗中的临床效果,选取本院50例低位直肠癌患者为研究对象,分为常规组与腹腔镜组,各25例。常规组给予传统开腹手术,腹腔镜组给予腹腔镜下全直肠系膜切除低位直肠保肛术治疗。观察比较2组治疗情况及术后并发症。结果显示,腹腔镜组患者在肛门排气时间、进食时间、术后离床时间、住院时间等方面均优于常规组,差异有统计学意义(P <0.05)。腹腔镜组术后并发症发生率(4.0%)低于常规组(24.0%);肛门功能优良率(48.0%)高于常规组(32.0%),差异均有统计学意义(P <0.05)。结果表明,低位直肠癌采取腹腔镜下全直肠系膜切除保肛术治疗,临床疗效满意,并发症发生率低,肛门功能优良。     

腹腔镜与开腹中低位直肠癌全直肠系膜切除保肛手术长期结果的meta分析

目的:通过meta分析比较腹腔镜与传统开腹全直肠系膜切除(total mesorectal excision,TME)保肛手术治疗中低位直肠癌长期结果的差异。方法:检索Pub Med、MEDLINE、Cochrane Library、中国生物医学文献服务系统(CBM)、万方数据库、中国知网数据库、维普等电子数据库。收集比较腹腔镜与开腹中低位直肠癌TME保肛手术的随机对照试验(randomized controlled trial,RCT)、非随机对照试验(non-randomized controlled trial,non-RCT)。统计分析使用Revman 5.2软件。结果:共将6篇文献纳入meta分析,1篇RCT,5篇non-RCT,共882例患者,其中腹腔镜组477例,开腹组405例。两组切缘阳性比值比(odds ratio,OR)=1.67,95%可信区间(confidence interval,CI)=(0.91,3.05)(P=0.10);吻合口瘘OR=1.03,95%CI=(0.57,1.87)(P=0.91);局部复发OR=0.71,95%CI=(0.16,3.15)(P=0.65);总生存率风险比(hazard ratio,HR)=0.98,95%CI=(0.90,1.07)(P=0.67);无病生存率HR=1.02,95%CI=(0.82,1.28)(P=0.85)。两组差异均无统计学意义。结论:腹腔镜中低位直肠癌TME保肛手术具有与传统开腹手术相似的长期结果。但目前仍需设计RCT评估患者术后长期肿瘤学结果及术后生活质量。     

低位直肠癌腹腔镜全直肠系膜切除术(附42例报告)

目的:探讨应用腹腔镜微创技术与常规开放手术施行全直肠系膜切除术(total m esorectal exc ision,TME)在手术切除的彻底性、功能性神经保护、近期并发症等方面的差异。方法:低位直肠癌患者89例,分为腹腔镜组与开放组,比较两组治疗结果的差别。结果:腹腔镜的放大效应和超声刀的应用,使腹腔镜组对解剖间隙的正确选择和手术径路更得心应手,能更好的辨认和保护盆腔自主神经,患者手术创伤小,出血少,康复快,并发症少。结论:腹腔镜TME较开放手术更规范化和标准化。     

腹腔镜直肠癌全直肠系膜切除保肛术611例分析

目的探讨腹腔镜直肠癌全直肠系膜切除（Total mesorectal excision,TME）保肛术的适应症、术式选择、操作要点及治疗效果。方法回顾单中心611例直肠癌TME前切除术,分析手术及近期随访资料。结果204例行高位吻合术,104例行低位吻合术,129例行超低位吻合术,余174例行结肠肛管吻合术。手术平均耗时117．8min,失血28．5ml。术中直肠损伤穿孔9例（1．5％）,术后吻合口瘘27例（4．4％）;患者术后平均2．8d始进流质饮食,平均住院日8．4d（5～15d）。术后排尿障碍32例（5．2％）,214例（91．8％）低位／超低位吻合病例术后控便功能良好。结论腹腔镜TME手术的适应证、治疗效果同开腹术式,腹膜后盆筋膜脏层与壁层解剖入路的准确定位及其间隙的锐性解剖技术是难点,是防止术中重要组织结构及邻近脏器损伤,减少术后并发症发生的关键。     

双器械吻合联合全直肠系膜切除在低位直肠癌保肛手术中的应用(附48例报告)

我国直肠癌以低位直肠癌多见,约占全部直肠癌的70%.随着对低位直肠癌生物学特性、浸润及淋巴结转移规律研究的不断深入,低位直肠癌中选择部分病例实施保肛可以达到根治.近3年,我们利用双器械吻合技术(double stapling technique,DST),在全直肠系膜切除(total mesorectal excision,TME)的基础上完成低位直肠癌保肛手术48例,现就其适应证及其根治性、安全性、术后排便功能加以探讨.     

腹腔镜缝合术在直肠癌超低位吻合术中的应用

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。     

腹腔镜直肠癌全直肠系膜切除术的临床应用

目的：探讨腹腔镜全直肠系膜切除术的临床应用。方法：回顾分析13例腹腔镜直肠全系膜切除术患者的临床资料。结果：13例均用腹腔镜完成手术,手术时间150-240min,平均165min,术中平均出血150ml。术后均无严重并发症发生,随访0.5-5年,无一例肿瘤复发,穿刺部位及造瘘口均无肿瘤种植。结论：腹腔镜全直肠系膜切除术具有较高的实用价值,在严格掌握手术适应证、不断提高手术技巧的基础上,腹腔镜直肠癌全直肠系膜切除术是可行的。     

腹腔镜全直肠系膜切除术治疗中低位直肠癌的Meta分析

目的系统评价腹腔镜全直肠系膜切除术（TME）治疗中低位直肠癌的临床疗效和安全性。方法检索1991--2012年公开发表的针对腹腔镜TME和开腹TME治疗中低位直肠癌疗效比较的随机对照研究,使用RevMan5．1软件对两种术式的疗效进行Meta分析。结果8篇文献被纳人分析,样本量共计863例中低位直肠癌患者,其中腹腔镜TME组428例,开腹TME组435例。合并分析结果显示,与开腹TME相比,腹腔镜TME可明显减少术中出血量（P〈0．01）,缩短术后肠道功能恢复时间（P〈0．01）及住院时间（P〈0．05）,降低术后出血（P〈0．05）及切口感染（P〈0．01）的发生率;而在手术时间、淋巴结清扫数目、术后吻合口瘘、肠梗阻及盆腔脓肿发生率方面。两种术式的差异无统计学意义（均P〉0．05）。结论腹腔镜TME能够达到与开腹TME相当的术中淋巴结清扫效果,而且能促进患者术后康复,降低术后切口感染和术后出血的发生率。     

腹腔镜下直肠癌全直肠系膜切除手术

目的 探讨腹腔镜下直肠癌全直肠系膜切除(total mesorectal excision，TME)手术的可行性。方法 自2000年3月至2003年11月共行腹腔镜下直肠癌TME手术67例，其中直肠癌前切除术(anterior resection，AR)45例，直肠癌腹会阴联合切除术(abdominal pelineal resection，APR)22例。结果 本组67例患者按TME原则采用腹腔镜完成直肠癌手术，术中出血量10～50ml，手术时间2.5～5．0h，无术中死亡，术后持续胃肠减压时间8～24h，平均术后24～48h开始进食水，术后1～3d下床活动，术后1～5d开始排便。术后住院时间7～10d。术后随访时间3～43个月，2例患者局部复发，2例患者肝转移；术后因局部复发和肝转移各死亡1例，失访3例；有19例术后不足1年的患者，未发现转移及复发。结论 只要有较好的开腹TME手术经验和腹腔镜操作技能，腹腔镜下直肠癌TME手术是可行的。     

The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma

Background Although experience of laparoscopic treatment of rectal carcinoma has been reported, there is no evidence of its oncological safety because most procedures included partial mesorectal excision or abdominoperineal excision and quality of surgery is lacking. The aim of this study was to assess the oncological results of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma.Methods From 2000 to 2003, 144 patients underwent laparoscopic total mesorectal excision with low colorectal or coloanal anastomosis for mid and low rectal adenocarcinoma. There were 88 men and 56 women, with a median age of 65 years. The tumor was located at 5.5 cm (range 1–12) from the anal verge and was classified uT1T2 in 25 cases and uT3 in 119 cases. One hundred twenty patients received preoperative radiotherapy.Results Postoperative mortality and morbidity were 1% and 34% respectively. Conversion was 14% (n = 20). Macroscopic assessment of the specimen (n = 92) showed an intact mesorectum in 88% of the cases. The distal margin and the circumferential margin were safe in 98% and 94% of the cases, respectively. A complete microscopic excision, i.e., R0 resection, was achieved in 134 cases (93%). Pathological data were similar to those of an open match group. With a median follow-up of 18 months, there was no port-site recurrence and two patients had local recurrence (1.4%). The 3-year overall and disease- free survival rates were 89% and 77%, respectively.Conclusions A high quality of surgical excision can be achieved by the laparoscopic dissection, suggesting that this approach in treatment of rectal carcinoma is oncologically safe.     

Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer

Background With advanced stereoscopic vision, lack of tremor, and the ability to rotate the instruments surgeons find that robotic systems are ideal laparoscopic tools. Because of its high operating cost, however, robotic surgery should be reserved to procedures in which the technology can be of maximum benefit, usually when precise dissections in confined spaces are required. Because conventional laparoscopic total mesorectal excision is a challenging procedure, we have sought to assess the utility of the DaVinci robotic system in laparoscopic low anterior resections for cancer of the rectum. Methods Between November 2004 and May 2005 robotic-assisted low anterior resection with total mesorectal excision was performed on six consecutive patients with rectal cancer. These cases were compared with six consecutive low anterior resections performed with conventional laparoscopic techniques by the same surgeon. Results There were no conversions in either group. Operative and pathological data, complications, and hospital stay were similar in the two groups. Robotic operations appeared to cause less strain for the surgeon. Conclusions Robotic-assisted laparoscopic low anterior resection for rectal cancer is feasible in experienced hands. This technique may facilitate minimally invasive radical rectal surgery. Presented, in part, at the 14th International Congress of the Society of Laparoendoscopic Surgeons, September 14–17, 2005 San Diego, California.     

腹腔镜辅助经肛门全直肠系膜切除术治疗中低位直肠癌的临床体会

目的:探讨腹腔镜辅助经肛门全直肠系膜切除术治疗中低位直肠癌的临床价值.方法:选取2018年5月至2019年3月为5例中低位直肠癌患者行腹腔镜辅助经肛门全直肠系膜切除术的相关临床资料.结果:5例均顺利完成手术,无中转开腹,2例行预防性回肠外置,手术时间平均(302.20±51.72)min,术中出血量(102.35±20...     

腹腔镜全直肠系膜切除术治疗直肠癌短期疗效及并发症的临床研究(附32例报告)

目的:探讨腹腔镜全直肠系膜切除术(TME)治疗直肠癌的短期临床疗效及并发症的预防。方法:回顾分析2001年至2004年行腹腔镜全直肠系膜切除术的直肠癌32例临床资料。结果:除1例外均在腹腔镜下完成手术,保肛率为90.6％,总并发症发生率为21.8％,局部复发率为6.2％,无手术死亡、术后肝转移及远处转移。平均术后胃肠功能恢复时间1.5d,平均住院时间12.4d。结论:腹腔镜全直肠系膜切除术治疗直肠癌的短期临床疗效可靠。严格掌握手术适应证、中转开腹指征及TME手术原则,提高腹腔镜技术水平是降低并发症发生率,提高短期手术疗效的关键。