摘要
目的探讨腹腔镜全系膜切除术（TME）联合经肛门内括约肌切除术（ISR）对超低位直肠癌的治疗效果。方法对接受腹腔镜TME联合经肛ISR手术的35例超低位直肠癌患者的临床和随访资料进行回顾性分析。结果35例患者肿瘤下缘距肛门2～5（平均3．4）cm；高、中分化腺癌32例，绒毛状腺瘤癌变3例；pTNMⅠ期16例，ⅡA期15例，ⅢA期3例，ⅢB期1例。术后末端回肠造口狭窄1例，吻合口瘘3例（均为未行末端回肠造E1者）。经4～49（中位时间16）个月的随访．1例患者出现吻合口复发．1例死于肝转移。随访满1年的19例患者术后1年排粪次数为1～4次／d．控便时间5min以上。结论腹腔镜TME联合经肛ISR治疗超低位直肠癌具有根治、保肛和微创的优点!侣廊进行严格的病例选择．
Objective To evaluate clinical outcomes after laparoscopic total mesorectal excision （TME） combined with intersphincteric resection （ISR） for ultra-low rectal tumors. Methods Clinical data of 36 patients with ultra-low rectal tumor undergoing laparoscopic TME combined with ISR were analyzed retrospectively. Results The median distance from the inferior margin of the tumor to the anal verge was 3.4 （2.0-5.0） cm. There were 33 cases of well/moderately differentiated adenocarcinoma and 3 rectal malignant villous adenoma. There were 16 patients with stage I disease, 15 with stage [I A, 3 with stage m A, and 1 with m B. Postoperatively, one patient developed stenosis at the end ileostomy and 3 anastomotic leakage. After a median follow-up of 16（4-49） months, one patient developed local recurrence at the anastomosis and one case died of liver metastasis. In the 19 patients who had a minimum follow-up of one year, the bowel movements frequency ranged from 1-4 times per day, and these patients were able to withhold defecation for more than 5 minutes. Conclusions Laparoscopic TME combined with ISR can achieve oncologic clearance, sphincter preservation, and minimal invasiveness for ultralower rectal cancer. However, patients selection should be cautious.
出处
《中华胃肠外科杂志》
CAS
北大核心
2011年第6期440-442,共3页
Chinese Journal of Gastrointestinal Surgery
基金
温州市科技局资助项目（Y20090190）
