CAJ | 학술논문

目的探讨腹腔镜直肠癌全直肠系膜切除(Total mesorectal excision, TME)保肛术的适应症、术式选择、操作要点及治疗效果.方法回顾单中心611例直肠癌TME前切除术,分析手术及近期随访资料.结果 204例行高位吻合术,104例行低位吻合术,129例行超低位吻合术,余174例行结肠肛管吻合术.手术平均耗时117.8 min,失血28.5 ml.术中直肠损伤穿孔9例(1.5%),术后吻合口瘘27例(4.4%);患者术后平均2.8 d始进流质饮食,平均住院日8.4 d(5～15 d).术后排尿障碍32例(5.2%),214例(91.8%)低位/超低位吻合病例术后控便功能良好.结论腹腔镜TME手术的适应证、治疗效果同开腹术式,腹膜后盆筋膜脏层与壁层解剖入路的准确定位及其间隙的锐性解剖技术是难点,是防止术中重要组织结构及邻近脏器损伤,减少术后并发症发生的关键.
목적 탐토복강경직장암전직장계막절제(Total mesorectal excision, TME)보항술적괄응증、술식선택、조작요점급치료효과.방법 회고단중심611례직장암TME전절제술,분석수술급근기수방자료.결과 204례행고위문합술,104례행저위문합술,129례행초저위문합술,여174례행결장항관문합술.수술평균모시117.8 min,실혈28.5 ml.술중직장손상천공9례(1.5%),술후문합구루27례(4.4%);환자술후평균2.8 d시진류질음식,평균주원일8.4 d(5～15 d).술후배뇨장애32례(5.2%),214례(91.8%)저위/초저위문합병례술후공편공능량호.결론 복강경TME수술적괄응증、치료효과동개복술식,복막후분근막장층여벽층해부입로적준학정위급기간극적예성해부기술시난점,시방지술중중요조직결구급린근장기손상,감소술후병발증발생적관건.
Objective To investigate the applicative indication, procedure selection, operating essentials and therapeutic effect of laparoscopic total mesorectal excision with anal sphincter preservation in patients with rectal cancer. Methods Six hundred and eleven patients from a single center were studied for surgical and short term results. Results Altogether 174 patients received coloanal anastomosis, while 204, 104 and 129 patients underwent high, low and ultra-low colorectal anastomosis, respectively. The average time for the operation was 117.8 minutes and blood loss was 28.5 ml. Nine patients had intraoperative rectal perforation, while 27 patients had anastomic leakage. The average time for liquid intake and hospitalization was 2.8 and 8.4 days after surgery, respectively. Thirty-two patients suffered from postoperative urinary dysfunction while 91.8% of the patients who had had low/ultralow anastomosis showed well-controlled defecation. Conclusions Laparoscopic TME is similar to open procedure in application and validity. The sharp dissection between the parietal and visceral pelvic fascia is essential to prevention of damage to adjacent tissues and postoperative complications.