摘要
目的:探讨腹腔镜联合经肛门拖出适形切除术治疗极低位直肠癌的手术安全性、可行性和经验体会。方法:2013年6月至2014年6月对8例符合Rullier极低位直肠癌外科学分类标准中Ⅱ、Ⅲ型病人施行腹腔镜联合经肛门拖出适形切除术。结果:本研究8例病人均在腹腔镜下完成切除手术,平均手术时间为(168.4±27.3)min,术中出血量(47.0±13.0)m L,远切缘距离(0.6±0.3)cm,肠系膜淋巴结(14.9±2.8)枚。1例术后发生骶前感染,经抗感染及引流后治愈。术后随访未发现肿瘤局部复发及远处转移病人,3例回肠造口还纳术后病人肛门功能良好。结论:治疗极低位直肠癌的腹腔镜联合经肛门拖出适形切除术是一种极限位保肛技术,决定能否保肛的最重要因素不是肿瘤与齿线距离,而是肿瘤对肛管直肠环的侵犯及类型。
Objective To investigate the safety and feasibility of laparoscopic resection combined with pull-through conformal resection for ultralow rectal cancer. Methods Eight cases with uhralow rectal cancer type Ⅱ and type Ⅲ classified by Rullier et al underwent the laparoscopic resection combined with pull-through conformal resection between June 2013 and June 2014. Results The laparoscopic resection combined with pull-through conformal resection was well done for all 8 patients. The operation time, blood loss, distant margin, and the number of mesenteric lymph node were （168.4± 27.3） min, （47.0±13.0） mL, （0.6±0.3） cm, and （14.9±2.8）, respectively. Presacral infection occurred postoperatively in only 1 case cured after anti-infection and drainage. Local recurrence and distant metastasis were not found in all patients during the follow-up. Three patients with ileostomy reversal had well anal function postoperatively. Conclusions Laparoscopic resection with puU-through conformal resection could be a promising anus-preserving procedure for ultralow rectal cancer. The indication of this procedure does not depend on the distance between tumor and dentate line, but the anorectal ring infiltrated by tumor and the type of infiltration.
出处
《外科理论与实践》
2014年第6期493-496,共4页
Journal of Surgery Concepts & Practice
基金
上海市科委基金引导类项目(134119a3800)
关键词
极低位直肠癌
腹腔镜
适形切除
拖出式
Uhralow rectal cancer
Laparoscopy
Conformal resection
Pull-through
