Fukunaga Yosuke, Higashino Masayuki, Tanimura Shinnya, Kishida Satoru, Fujiwara Yushi, Ogata Akihito, Osugi H
Division of Gastroenterological Surgery, Osaka City General Hospital, Japan.
Hepatogastroenterology. 2007 Jan-Feb;54(73):85-90.
BACKGROUND/AIMS: Laparoscopic mesorectal excision with preservation of the autonomic pelvic nerves for rectal cancer including selected advanced lower rectal cancer is now challenging. The aims of the study were to assess the surgical results and short-term outcomes of this procedure prospectively.
Seventy-four of 281 rectal cancer patients, since the introduction of laparoscopic colorectal surgery in our hospital, have undergone laparoscopic rectal surgery. The location of the tumor distributed in upper rectum; 33, middle; 22, and lower 19. The mesorectal excision with preservation of the autonomic pelvic nerves was performed for all the patients. The laparoscopic mesorectal excision was performed under 8 to 10 cmH2O CO2 pneumoperitoneum and lymph node dissection was performed along the feeding artery depend on individuals. Ipsilateral lateral lymph node dissection was added for 5 cases of advanced lower rectal cancer.
Open conversion occurred in 4 cases, 2 of those were due to locally advanced tumors and 2 technical difficulties in transaction of the distal rectum. There were 15 postoperative complications, 7 anastomotic leakage (10.6%), 3 transient urinary retention (4.1%), 4 wound infection (5.3%), and 1 small bowel obstruction (1.4%). No mortality was recorded in this series. Time of operation was 203 +/- 54 min in mesorectal excision cases and 270 +/- 42 min mesorectal excision with lateral lymph node dissection cases. Blood loss was 92 +/- 90g and 276 +/- 66 g respectively. The hospital length-of-stay was 11.7 days in average.
Laparoscopic mesorectal excision with preservation of autonomic pelvic nerves for rectal cancer patients including selected advanced lower rectal cancer is favorable.
背景/目的：对于包括部分晚期低位直肠癌在内的直肠癌患者，保留自主盆腔神经的腹腔镜直肠系膜切除术目前具有挑战性。本研究的目的是前瞻性评估该手术的手术结果和短期预后。
自我院开展腹腔镜结直肠手术以来，281例直肠癌患者中有74例接受了腹腔镜直肠手术。肿瘤位置分布在上段直肠33例、中段22例、下段19例。所有患者均行保留自主盆腔神经的直肠系膜切除术。腹腔镜直肠系膜切除术在8至10 cmH2O二氧化碳气腹下进行，淋巴结清扫根据个体情况沿供血动脉进行。5例晚期低位直肠癌患者加做同侧侧方淋巴结清扫。
4例中转开腹，其中2例是由于局部进展期肿瘤，2例是直肠远端处理的技术困难。术后有15例并发症，7例吻合口漏（10.6%），3例短暂性尿潴留（4.1%），4例伤口感染（5.3%），1例小肠梗阻（1.4%）。本系列无死亡病例。直肠系膜切除病例的手术时间为203±54分钟，直肠系膜切除加侧方淋巴结清扫病例为270±42分钟。失血量分别为92±90克和276±66克。平均住院时间为11.7天。
对于包括部分晚期低位直肠癌在内的直肠癌患者，保留自主盆腔神经的腹腔镜直肠系膜切除术效果良好。
