Tsang W W C, Chung C C, Li M K W
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, Special Administrative Region, China.
Br J Surg. 2003 Jul;90(7):867-71. doi: 10.1002/bjs.4105.
Results of laparoscopic sphincter-preserving total mesorectal excision and colonic J-pouch reconstruction are few. The aim of this study was to examine outcomes after this procedure.
Patients with mid or low rectal cancer underwent laparoscopic total mesorectal excision with construction of a colonic J pouch, performed by a single surgeon. The patients were evaluated prospectively.
From March 1999 to January 2002, 44 patients underwent laparoscopic total mesorectal excision with colonic J-pouch reconstruction. There were 21 men and 23 women of median age 65.5 years. The median operating time was 180 min and median blood loss 80 ml. There was no conversion to an open procedure. The median distance of the anastomosis from the anal verge was 4 cm. No procedure-related death occurred. Four patients developed significant complications that required reoperation. With a median follow-up period of 15 months, no port-site recurrence was noted. Five patients developed distant metastases, and two had local recurrence in the pelvis. Bowel function was satisfactory at 6, 12 and 18 months after ileostomy closure.
Laparoscopic total mesorectal excision with colonic J-pouch reconstruction is safe, with a reasonable operating time. Early results suggest satisfactory oncological control and functional outcomes.
腹腔镜保留括约肌全直肠系膜切除术联合结肠J形贮袋重建术的相关结果报道较少。本研究旨在探讨该手术的疗效。
中低位直肠癌患者接受由单一外科医生实施的腹腔镜全直肠系膜切除术并构建结肠J形贮袋。对患者进行前瞻性评估。
1999年3月至2002年1月，44例患者接受了腹腔镜全直肠系膜切除术联合结肠J形贮袋重建术。其中男性21例，女性23例，中位年龄65.5岁。中位手术时间为180分钟，中位失血量为80毫升。无中转开腹手术情况。吻合口距肛缘的中位距离为4厘米。无手术相关死亡病例。4例患者出现严重并发症，需要再次手术。中位随访期为15个月，未发现切口部位复发。5例患者发生远处转移，2例盆腔出现局部复发。回肠造口关闭后6个月、12个月和18个月时肠道功能良好。
腹腔镜全直肠系膜切除术联合结肠J形贮袋重建术是安全的，手术时间合理。早期结果显示肿瘤学控制和功能结局良好。
