摘要
目的评价腹腔镜下超低位直肠癌保肛术的安全性及临床价值。方法应用超声刀在腹腔镜下对43例超低位直肠癌患者实施全直肠系膜切除原则的根治性手术,肛门部用二联式手工吻合法完成结-直肠/肛管吻合。术后3、6个月测试其直肠肛管功能,包括每日排便次数、排便感觉及控便功能。结果 43例患者手术经过均顺利,全组无手术死亡病例,术后发生吻合口瘘4例(占9.3%),肛门粪渍性湿疹8例(占18.6%),术后局部复发4例(占9.3%),随访中有2例死亡;2～3个月恢复预感便意,3～4个月恢复控便能力,平均每天排便3～4次,无大便失禁,术后6个月排便控制优良率达88.37%,6个月后各项测试结果与术前比较无统计学差异。结论超低位直肠癌行腹腔镜下超低位切除、肛门部二联式手工吻合保肛术具有安全、经济、创伤小、疗效可靠,住院时间短等优点。
Objective To evaluate the clinical value and safety of manual anastomosis with two operations out of anus in laparoseopie anal sphincter preserving resection of ultra low rectal cancer. Methods Radical excision of ultra low rectal cancer was performed with ultrasonic scalpel on 43 patients based on the concept of total mesoreetal excision （TME） , and ultra low colorectal/anal anastomosis was performed by applying the manual anastomosis with two operations out of anus. The function of the rectus and anus was tested, including stool frequency per day 3 and 6 months after operation and function of bowel feeling and control. Results All the operations were finished successfully without operative death. Out of the patients, 4 suffered from anastomotic leakage （9.3%） , 8 from per[anal fecal stained eczema （ 18.6% ）, and 4 from local tumor recurrence （9.3%）. Two patients died during the follow- up. The other ones reeovered excretion intention within 2 - 3 months and excretion control within 3 - 4 months. They defecated 3 - 4 times every clay from then on. Without fecal incontinence, postoperative anal continence was satisfactory in about 88.37% of the patients after 6 months ; the results of tests were near to normal level Conclusion The manual anastomosis with two operations out of anus in laparoscopie anal sphincter preserving resection of ultra low rectal cancer is safe, economical, effective, minimally inva- sive and short in hospital stay.
出处
《临床军医杂志》
CAS
2013年第4期366-368,共3页
Clinical Journal of Medical Officers
关键词
腹腔镜
超低位直肠癌
疗效评价
保肛术
laparoseopy
ultra low recta] cancer
clinical evaluation
anal sphincter preserving procedure
