Nedelcu Marius, Andreica Anamaria, Skalli Mehdi, Pirlet Isabelle, Guillon Françoise, Nocca David, Fabre Jean Michel
Department of Surgery A, Saint Eloi Hospital, CHRU Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier Cedex 5, France,
Surg Endosc. 2013 Nov;27(11):4177-83. doi: 10.1007/s00464-013-3017-1. Epub 2013 Jun 1.
Retrorectal tumors are uncommon and may represent a surgical challenge. Laparoscopic excision has been reported in very few papers. We present our experience of nine cases operated by a transabdominal laparoscopic approach, between 2005 and 2011.
There were two males and seven females with a mean age of 35 years (range 19-48). The tumors were discovered incidentally in four cases or because of nonspecific clinical signs. All patients have had an MRI preoperatively.
Only one patient required open conversion due to a huge tumor >7 cm of diameter. Postoperative mortality was nil. One patient developed a hematoma in the pelvic area. The median hospital stay was 4.7 days (range 4-8). Final diagnostic were as follows: four schwannomas, one ganglioneuroma, two tailgut cysts, one anterior meningocele, and one paragangliomas. During the follow-up showed no recurrences, but four of nine patients developed neurologic complications as parenthesis and sciatic pain and one patient developed retrograde ejaculation.
Our case series shows that the laparoscopic approach is a feasible and safe option. It reduces surgical trauma and offers an excellent tool for perfect visualization of the deep structures in the presacral space to minimize the vascular and neurological injuries.
直肠后肿瘤并不常见，可能是手术挑战。仅有极少论文报道过腹腔镜切除术。我们介绍2005年至2011年间经腹腹腔镜手术治疗9例患者的经验。
9例患者中，男性2例，女性7例，平均年龄35岁（19 - 48岁）。4例肿瘤为偶然发现，其余因非特异性临床症状发现。所有患者术前均行MRI检查。
仅1例因肿瘤直径>7 cm巨大而中转开腹。术后无死亡病例。1例患者盆腔出现血肿。中位住院时间为4.7天（4 - 8天）。最终诊断如下：4例神经鞘瘤，1例神经节瘤，2例尾肠囊肿，1例前位脑脊膜膨出，1例副神经节瘤。随访期间无复发，但9例患者中有4例出现括号和坐骨神经痛等神经并发症，1例患者出现逆行射精。
我们的病例系列表明，腹腔镜手术是一种可行且安全的选择。它减少了手术创伤，为完美可视化骶前间隙深部结构提供了极佳工具，以尽量减少血管和神经损伤。
