现代消化及介入诊疗
現代消化及介入診療
현대소화급개입진료
MODERN DIGESTION & INTERVENTION
2013年
3期
159-162
,共4页
陈远光%梁剑荣%胡明%雷建%黄炯强%成武%王荣%曾毅克%夏同义%陈劲松%柯传烽
陳遠光%樑劍榮%鬍明%雷建%黃炯彊%成武%王榮%曾毅剋%夏同義%陳勁鬆%柯傳烽
진원광%량검영%호명%뢰건%황형강%성무%왕영%증의극%하동의%진경송%가전봉
直肠肿瘤%经肛%自然腔道内镜手术%腹腔镜
直腸腫瘤%經肛%自然腔道內鏡手術%腹腔鏡
직장종류%경항%자연강도내경수술%복강경
Rectal neoplasms%Transanal%Natural orifice transluminal endoscopic surgery%Laparoscopy
目的探讨腹腔镜辅助经肛内镜直肠癌根治术的安全性、可行性及近期效果，并探讨经肛内镜和经腹腹腔镜两者同步使用是否优于序贯使用。方法回顾性分析19例中下段直肠癌患者腹腔镜辅助经肛内镜直肠癌根治术及术后恢复情况，并将经肛内镜和经腹腹腔镜序贯进行（序贯组，前9例）和同步进行（同步组，后10例）进行比较。结果19例平均手术时间（3.85±0.98）h，中位术中出血量为80（50，120）ml，平均检出21.89±9.21个淋巴结，术后首次下床活动时间（2.09±0.94）d，肛门功能恢复正常时间（7.95±3.49）d；16例系膜大体标本完整3例接近完整；有2例中转为腹腔镜辅助直肠癌根治术，2例吻合口漏，1例局部复发再次手术局部切除，无输尿管损伤、骶前大出血、腹腔感染、手术死亡。同步组与序贯组比较，平均手术时间[（3.39±0.96）h vs.（4.36±0.75）h]、术后首次下床活动时间[（2.10±0.99)d vs.（3.78±1.56）d]减少明显（P＜0．05）。结论腹腔镜辅助经肛内镜直肠癌根治术较为安全可行，基本上不影响肿瘤根治性，经肛内镜和经腹腹腔镜两者同步使用较序贯使用手术时间更短恢复更快。
目的探討腹腔鏡輔助經肛內鏡直腸癌根治術的安全性、可行性及近期效果，併探討經肛內鏡和經腹腹腔鏡兩者同步使用是否優于序貫使用。方法迴顧性分析19例中下段直腸癌患者腹腔鏡輔助經肛內鏡直腸癌根治術及術後恢複情況，併將經肛內鏡和經腹腹腔鏡序貫進行（序貫組，前9例）和同步進行（同步組，後10例）進行比較。結果19例平均手術時間（3.85±0.98）h，中位術中齣血量為80（50，120）ml，平均檢齣21.89±9.21箇淋巴結，術後首次下床活動時間（2.09±0.94）d，肛門功能恢複正常時間（7.95±3.49）d；16例繫膜大體標本完整3例接近完整；有2例中轉為腹腔鏡輔助直腸癌根治術，2例吻閤口漏，1例跼部複髮再次手術跼部切除，無輸尿管損傷、骶前大齣血、腹腔感染、手術死亡。同步組與序貫組比較，平均手術時間[（3.39±0.96）h vs.（4.36±0.75）h]、術後首次下床活動時間[（2.10±0.99)d vs.（3.78±1.56）d]減少明顯（P＜0．05）。結論腹腔鏡輔助經肛內鏡直腸癌根治術較為安全可行，基本上不影響腫瘤根治性，經肛內鏡和經腹腹腔鏡兩者同步使用較序貫使用手術時間更短恢複更快。
목적탐토복강경보조경항내경직장암근치술적안전성、가행성급근기효과，병탐토경항내경화경복복강경량자동보사용시부우우서관사용。방법회고성분석19례중하단직장암환자복강경보조경항내경직장암근치술급술후회복정황，병장경항내경화경복복강경서관진행（서관조，전9례）화동보진행（동보조，후10례）진행비교。결과19례평균수술시간（3.85±0.98）h，중위술중출혈량위80（50，120）ml，평균검출21.89±9.21개림파결，술후수차하상활동시간（2.09±0.94）d，항문공능회복정상시간（7.95±3.49）d；16례계막대체표본완정3례접근완정；유2례중전위복강경보조직장암근치술，2례문합구루，1례국부복발재차수술국부절제，무수뇨관손상、저전대출혈、복강감염、수술사망。동보조여서관조비교，평균수술시간[（3.39±0.96）h vs.（4.36±0.75）h]、술후수차하상활동시간[（2.10±0.99)d vs.（3.78±1.56）d]감소명현（P＜0．05）。결론복강경보조경항내경직장암근치술교위안전가행，기본상불영향종류근치성，경항내경화경복복강경량자동보사용교서관사용수술시간경단회복경쾌。
Objective To investigate the safety, feasibility and short-term outcomes of transanal endo-scopic radical resection for rectal carcinoma with laparoscopic assistance, and to determine if synchronous use is superior to sequential use of transanal endoscopic and transabdominal laparoscopic procedure. Methods The clinical data of 19 patients with rectal carcinoma treated with the procedure were retrospectively analyzed,and the results of synchronous group (the latter 10 cases) were compared to what of sequential group (the former 9 cases). Results Among 19 consecutive patients, two cases were conversed to laparoscopic procedure. The mean operative time, median blood loss, mean number of lymph nodes harvested, mean time of first ambula-tion, mean time of anal function recovery were ( 3.85 ± 0.98)h, 80(50, 120)ml, (21.89 ± 9.21), (2.09 ± 0.94) d, (7.95 ± 3.49)d, respectively. Macroscopic evaluation of 16 specimens were classified as complete, 3 as nearly complete. Two patients developed postoperative anastomotic leakage. One patient encounted local recurrence and was treated with local R0 resection. There were no ureteral injury, presacral hemorrhage, abdominal infec-tion and mortality. Compared to sequential group,the synchronous group showed significant decrease of opera-tive time (3.39 ± 0.96 vs. 4.36 ± 0.75 h,P<0.05)and mean time of first ambulation (2.10 ± 0.99 vs. 3.78 ± 1.56 d,P<0.05). Conclusion Transanal endoscopic radical resection for rectal carcinoma with laparoscopic Assistance is safe, feasible and radical, synchronous use is superior to sequential use of transanal endoscopic and transabadominal laparoscopic procedure.
