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。

Laparoscopic total mesorectal excision for low or ultralow anterior resection of rectal cancer with anal sphincter preservation

Objective To assess the feasibility of laparoscopic total mesorectal excision (TME) for low or ultralow anterior resection of rectal cancer.Methods Excision of the mesorectum and low (ultralow) colo-anal anastomoses were performed laparoscopically in 62 patients with low rectal cancer based on the concept of TME and double stapling technique (DST). Results Sixty-two operations with TME and DST were performed in a totally laparoscopic manner, and only one was converted to open procedures because of dysfunction of coagulation. The operative time was 125 min (110-210 min) and the operative blood loss 20 ml (5-80 ml). The time for bowel function recovery and post-operatively dietary intake was 1-2 days. Twenty-eight patients received postoperative analgesics. Average hospital stay was 8 days (5-14 days). Complications were observed in only 2 of the 62 patients, one had suffered from urinary retention and the other, anastomotic leakage. Conclusions Totally laparoscopic excision of the mesorectum for low or ultralow aterior resection of rectal cancer is a minimally invasive technique with sphincter preservation, less postoperative pain, and rapid recovery.