腹腔镜下括约肌间切除联合结肠成形术及结肠肛管吻合术治疗中低位直肠癌
Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer.
作者信息
Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J
机构信息
Department of Surgery, Saint-André Hospital, Bordeaux, France.
出版信息
Br J Surg. 2003 Apr;90(4):445-51. doi: 10.1002/bjs.4052.
BACKGROUND
The feasibility of laparoscopic rectal resection in patients with mid or low rectal cancer was studied prospectively with regard to quality of mesorectal excision, autonomic pelvic nerve preservation and anal sphincter preservation.
METHODS
Laparoscopic rectal excision was performed in 32 patients (21 men) with rectal carcinoma located 5 cm from the anal verge. Most patients had T3 disease and received preoperative radiotherapy. The surgical procedure was performed 6 weeks after radiotherapy and included total mesorectal excision, intersphincteric resection, transanal coloanal anastomosis with coloplasty and loop ileostomy.
RESULTS
Three patients needed conversion to a laparotomy. Postoperative morbidity occurred in ten patients, related mainly to coloplasty. Macroscopic evaluation showed an intact mesorectal excision in 29 of 32 excised specimens; microscopically, 30 of the 32 resections were R0. Sphincter preservation was achieved in 31 patients. The hypogastric nerves and pelvic plexuses were identified and preserved in 24 of the 32 patients. Sexual function was preserved in ten of 18 evaluable men.
CONCLUSION
A laparoscopic approach can be considered in most patients with mid or low rectal cancer.
背景
前瞻性研究了腹腔镜直肠切除术治疗中低位直肠癌患者在直肠系膜切除质量、自主盆腔神经保留及肛门括约肌保留方面的可行性。
方法
对32例（21例男性）距肛缘5 cm的直肠癌患者实施腹腔镜直肠切除术。大多数患者患有T3期疾病并接受了术前放疗。放疗6周后进行手术，手术包括全直肠系膜切除、括约肌间切除、经肛门结肠肛管吻合术并结肠成形术及回肠袢造口术。
结果
3例患者需中转开腹。10例患者发生术后并发症，主要与结肠成形术有关。大体评估显示32个切除标本中有29个直肠系膜切除完整；显微镜检查显示，32例切除中有30例为R0切除。31例患者实现了括约肌保留。32例患者中有24例识别并保留了腹下神经和盆腔神经丛。18例可评估男性中有10例性功能得以保留。
结论
大多数中低位直肠癌患者可考虑采用腹腔镜手术方式。
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