Department of Surgery, James Cook University, IMB 52, The Townsville Hospital, 100 Angus Smith Drive, Douglas, Queeensland 4811, Australia.
Am J Surg. 2011 Sep;202(3):291-7. doi: 10.1016/j.amjsurg.2010.09.027.
Ultralow anterior resection for mid and distal rectal cancers has been reported routinely performed using either a laparoscopic ultralow anterior resection (LAR) or laparoscopic pull-through with coloanal anastomosis (LPT). This study evaluated the postoperative and functional outcomes.
Between January 2007 and December 2008, 40 consecutive patients had laparoscopic surgery for rectal cancers. The data were prospectively collected.
There were 21 patients (21 men; mean age 61.2 ± 3.2 years standard error of the mean [SEM]) in the LAR group and 19 (16 men; mean age 61.4 ± 2.4 years SEM) in the LPT group. Tumor characteristics, adjuvant therapy given, mean follow-up (overall 33.5 ± 1.4 months SEM), intraoperative time, blood loss, mesorectum quality, conversion rate (LAR n = 2, LPT n = 1), pain score, time for ileostomy to function, subsequent incontinence scores, and complication rates (LAR n = 7, LPT n = 9) were not different between groups, but benign anastomotic strictures were higher after LPT (n = 4, LAR n = 0, P = .042). The latter was associated with chemoradiotherapy (P = .015). There were 2 systemic cancer recurrences both in the LPT group but no local recurrences to date.
The LAR technique may have less risk of anastomotic strictures, particularly with adjuvant therapy. LPT may be considered selectively for a bulky distal rectal tumor in a small pelvis with comparable functional results.
中低位直肠肿瘤的超低位直肠前切除术已经常规采用腹腔镜超低位直肠前切除术（LAR）或腹腔镜经肛拖出结肠直肠吻合术（LPT）进行。本研究评估了术后和功能结果。
2007 年 1 月至 2008 年 12 月，40 例连续接受直肠肿瘤腹腔镜手术的患者纳入本前瞻性研究。
LAR 组 21 例（21 例男性；平均年龄 61.2 ± 3.2 岁，标准误差均值 [SEM]），LPT 组 19 例（16 例男性；平均年龄 61.4 ± 2.4 岁 SEM）。两组肿瘤特征、辅助治疗、平均随访时间（总体 33.5 ± 1.4 个月 SEM）、手术时间、出血量、直肠系膜质量、中转开腹率（LAR 组 2 例，LPT 组 1 例）、疼痛评分、回肠造口功能恢复时间、后续失禁评分和并发症发生率（LAR 组 7 例，LPT 组 9 例）无显著差异，但 LPT 后良性吻合口狭窄发生率更高（LPT 组 4 例，LAR 组 0 例，P =.042），与放化疗相关（P =.015）。LPT 组有 2 例系统癌症复发，但均无局部复发。
LAR 技术吻合口狭窄风险可能较低，尤其是在辅助治疗后。对于骨盆较小、肿瘤较大的患者，LPT 可作为一种选择，其功能结果可与之相媲美。
