摘要
目的探讨经肛门内镜联合腹腔镜行全直肠系膜切除术的安全性和可行性。方法回顾性分析2014年11月至2015年6月间在北京协和医院基本外科结直肠专业组接受肛门内镜联合腹腔镜行全直肠系膜切除的17例低位直肠癌患者的临床资料。主要观察指标为手术时间、术中出血量、术中术后并发症的发生率、病理标本下切缘的距离、环周切缘的完整性和淋巴结清扫的枚数。结果17例患者中体质指数（BMI）超过25kg／m2的有7例。全组患者均顺利完成手术，无中转开腹。手术时间（178．0±32．3）min，术中出血（50．6±44．0）ml，术中并发骶前静脉出血1例（5．9％）。术后发生吻合口瘘3例（17．6％）。标本远切端距肿瘤下缘（2．2±1．6）cm，远近切缘和环周切缘病理学检查均为阴性，获检淋巴结（14．5±6．9）枚。术后住院时间（10．6±6．7）d。术后随访（7．0±2．6）月，除肝转移癌并发上消化道大出血死亡1例外，其余病例均存活，尚未发现有肿瘤复发和转移。结论经肛门内镜联合腹腔镜的直肠全系膜切除在技术上安全可行。
Objective To investigate the safety and feasibility of transanal endoscopic microsurgery combined with laparoscopic total mesorectal resection for lower rectal cancer. Method Clinical data of seventeen patients with low rectal cancer undergoing the transanal endoscopic microsurgery combined with laparoscopic total mesorectal resection in our department from November 2014 to June 2015 were retrospectively analyzed. The main outcome measures included the operative time, intra-operative blood loss, the intra- and post-operative complication rate, the distal resection margin （DRM） length and the circumferential resection margin （CRM） status of the pathological specimen, as well as the number of lymph nodes retried. Results The surgery was completed smoothly for all the patients in this studying group, with no conversion to open surgery. Among all the seventeen patients, seven had a body mass index （BMI） of over 25. The average operative time was （178.0 ＋ 32.3） min. The average intra-operative blood loss was （50.6 ± 43.98） ml. The complications included one case of intra-operative presacral venous hemorrhage （5.9%）, and 3 cases of post-operative anastomotic leak （17.6%）. The average distance from the distal resection margin to the lower edge of the tumor was （2.2 ± 1.6） cm. The distal, proximal, and circumferential resection margins were all negative in 17 patients. The average number of lymph nodes retrieved was 14.5 ± 6.9. The average postoperative hospital stay was （10.6 ± 6.7） d. Patients were followed up for an average period of （7.0± 2.6） months. Conclusion Transanal endoscopic microsurgery combined with laparoscopie total mesorectal resection in the treatment of lower rectal cancer is technically safe and feasible.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2016年第1期41-44,共4页
Chinese Journal of Gastrointestinal Surgery
关键词
直肠肿瘤
经肛门内镜显微手术
全直肠系膜切除术
经自然腔道内镜手术
腹腔镜
Rectal neoplasms
Transanal endoscopic microsurgey
Total mesorectal excision
Natural orifice translumenal endoscopic surgery
Laparoscopy
