Chen Jian, Bo Yan-Zhi, Han Feng, Wang Shu-Zhong, Wu Kun, Zhang Jie, Xia Tian-Fang, Qing Zhen-Shen, Pang Li-Qun
Department of General Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China.
Department of General Surgery, Lian'shui County People's Hospital, Lianshui, China.
Wideochir Inne Tech Maloinwazyjne. 2019 Apr;14(2):210-215. doi: 10.5114/wiitm.2019.81316. Epub 2019 Jan 16.
Colorectal cancer is the third most common cancer causing death in Western countries; laparoscopic surgery for colorectal cancer has many advantages and thus has been used widely. Laparoscopic total mesorectal excision through the sacrococcygeal incision under direct visualization to excise distal rectal cancer is an important procedure for super-low rectal carcinomas.
To investigate the feasibility of mesorectal excision and super-low rectal carcinoma excision using the intersphincteric approach through the sacrococcygeal incision.
From December 2009 to June 2017, intersphincteric resection was performed through the sacrococcygeal incision; the mesentery was excised in 27 patients with rectal cancer and a contracted pelvis (the lower edge of the tumor was 4 to 7 cm to the anal verge) through laparoscopy in the Gastrointestinal Surgery Department of our hospital.
No death was recorded during surgery. The surgical time ranged from 190 to 310 min, the bleeding volume was 50 to 150 ml, and the post-surgical length of stay was 6 to 19 days. There were three cases of anastomotic fistulas, one case of anastomotic stenosis, and one case of fecal incontinence. Follow-up visits were scheduled for 19 patients, with a mean time of 37 months, ranging from 3 to 92 months; one case of local recurrence, one case of peritoneal metastasis, and two cases of hepatic metastasis were observed.
Laparoscopic total mesorectal excision using the intersphincteric approach through the sacrococcygeal incision is feasible for treating patients with a contracted pelvis and super-low rectal carcinoma.
结直肠癌是西方国家导致死亡的第三大常见癌症；结直肠癌的腹腔镜手术具有诸多优势，因此已被广泛应用。经骶尾切口在直视下进行腹腔镜全直肠系膜切除术以切除低位直肠癌是超低位直肠癌的重要手术方式。
探讨经骶尾切口采用括约肌间入路行直肠系膜切除及超低位直肠癌切除的可行性。
2009年12月至2017年6月，我院胃肠外科对27例骨盆狭窄（肿瘤下缘距肛缘4至7cm）的直肠癌患者经骶尾切口行括约肌间切除术，并通过腹腔镜切除系膜。
手术期间无死亡病例。手术时间为190至310分钟，出血量为50至150毫升，术后住院时间为6至19天。发生吻合口瘘3例，吻合口狭窄1例，大便失禁1例。对19例患者进行随访，平均时间为37个月，范围为3至92个月；观察到局部复发1例，腹膜转移1例，肝转移2例。
经骶尾切口采用括约肌间入路行腹腔镜全直肠系膜切除术治疗骨盆狭窄及超低位直肠癌患者是可行的。
