摘要
目的 探讨经腹经肛全直肠系膜切除联合肝转移灶切除术治疗同时性低位直肠癌肝转移的应用价值.方法 采用回顾性描述研究方法.收集2015年11月北京大学第三医院收治的1例同时性低位直肠癌肝转移患者的临床资料.经多学科团队讨论决定行经腹经肛全直肠系膜切除联合肝转移灶切除术.先经腹腔完成肝转移灶切除、血管离断和淋巴结清扫,以及中上段直肠系膜的游离.然后经肛入路完成下段直肠系膜切除,以及直肠和肝脏切除标本的取出.观察患者术中情况（手术方式、手术时间、术中出血量、输血情况）、术后并发症发生情况、病理学检查结果以及随访情况.术后采用门诊方式进行随访,随访时间截至2016年1月.结果 患者顺利完成手术,围术期无严重并发症发生.手术时间为360 min,术中出血量约为170 mL,术中未输血.患者术后无尿潴留、骶前脓肿等并发症发生.患者术后9d出院.术后病理学检查结果：直肠隆起型高分化腺癌,大小为5.0cm×5.0 cm×1.5 cm;肝组织中可见高-中分化腺癌转移,转移灶大小为1.5cm×1.0cm×1.5 cm,各切缘阴性.TNM分期为Ⅳ期（pT3N0M1期）.术后门诊随访1个月,患者生命质量良好.结论 经腹经肛入路为同时性低位直肠癌肝转移患者提供了新的手术入路和切除方式,近期疗效较好.
Objective To investigate the application value of transabdominal-tansanal total mesorectal excision combined with liver metastasis resection for synchronous low rectal liver metastasis.Methods The retrospective descriptive study was adopted.The clinical data of a male patient with synchronous low rectal liver metastasis who was admitted to the Peking University Third Hospital in November 2015 was collected.Transabdominal-transanal total mesorectal excision combined with liver metastasis resection was performed after multidisciplinary team conference.The liver metastasis resection,vascular disconnection,lymph node dissection and upper and middle mesorectal disconnection were done by transabdominal approach.Then complete mesorectal excision and specimen removal of rectum and liver were done by transanal approach.The intraoperative status （operation method,operation time,volume of intraoperative blood loss,blood transfusion）,occurrence of postoperative complications,results of pathological examination and follow-up were observed.The patient was followed up by outpatient examination till January 2016.Results The operation was performed successfully without severe perioperative complications.The operation time and volume of intraoperative blood loss were 360 minutes and 170 mL,respectively.The patient did not receive intraoperative blood transfusion,without urinary retention and presacral abscesses.The patient was discharged at postoperative day 9.The postoperative pathological results showed high-differentiated rectal protruded adenoma and high-middle differentiated adenocarcinoma metastasis in the liver tissue with the negative resection margins.The tumor sizes of rectum and liver metastasis were 5.0 cm × 5.0 cm× 1.5 cm and 1.5 cm × 1.0 cm × 1.5 cm,respectively.The tumor node metastasis （TNM） stage was stage Ⅳ （pT3N0M1）.The patient had a good life quality during the follow-up of 1 month.Conclusion Transabdominal-transanal approach might provide an alternative operative approach and resection method
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2016年第2期123-127,共5页
Chinese Journal of Digestive Surgery
基金
国家临床重点建设专科项目基金[卫办医改函（2012）650号]
关键词
直肠肿瘤
肝转移
经腹经肛
全直肠系膜切除术
Rectal neoplasms
Liver metastases
Transabdominal-transanal
Total mesorectal excision
