中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2015年
8期
821-825
,共5页
叶景旺%黄彬%童卫东%付涛%李春穴%王祥峰%赵松%王李%石磊%刘宝华
葉景旺%黃彬%童衛東%付濤%李春穴%王祥峰%趙鬆%王李%石磊%劉寶華
협경왕%황빈%동위동%부도%리춘혈%왕상봉%조송%왕리%석뢰%류보화
直肠肿瘤%全直肠系膜切除术%经肛门微创手术%经自然腔道手术
直腸腫瘤%全直腸繫膜切除術%經肛門微創手術%經自然腔道手術
직장종류%전직장계막절제술%경항문미창수술%경자연강도수술
Rectal neoplasms%Total mesorectal excision%Transannal minimally invasive surgery%Nataral orifice transluminal endoscopic surgery
目的:探讨完全经肛门或联合腹腔镜的全直肠系膜切除术治疗直肠癌的可行性与安全性。方法回顾性收集2014年9月至2015年5月间于第三军医大学大坪医院行完全经肛门全直肠系膜切除术(taTME)或联合腹腔镜taTME的11例直肠癌患者临床资料。结果全组11例患者中3例顺利完成完全taTME手术,手术时间分别为210、230和215 min;8例采用腹腔镜联合taTME手术,手术时间150~290(中位数205) min。全组无中转开腹病例,但有2例患者因肿瘤偏大,而取下腹部约5 cm切口取出标本。全组患者术后第1天视觉模拟评分法(VAS)评分为1~3(2.0±0.6),术后排气时间6~70(30.2±17.3) h,术后住院时间4~12(7.5±2.5) d。全组患者发生术后皮下气肿1例,吻合口出血1例,排尿困难2例,均经保守治疗好转;1例术后第20天发现直肠阴道瘘行回肠造口术。随访期间,全组患者无肿瘤复发及死亡。结论对于合适的患者,taTME或联合腹腔镜taTME手术是安全可行的。
目的:探討完全經肛門或聯閤腹腔鏡的全直腸繫膜切除術治療直腸癌的可行性與安全性。方法迴顧性收集2014年9月至2015年5月間于第三軍醫大學大坪醫院行完全經肛門全直腸繫膜切除術(taTME)或聯閤腹腔鏡taTME的11例直腸癌患者臨床資料。結果全組11例患者中3例順利完成完全taTME手術,手術時間分彆為210、230和215 min;8例採用腹腔鏡聯閤taTME手術,手術時間150~290(中位數205) min。全組無中轉開腹病例,但有2例患者因腫瘤偏大,而取下腹部約5 cm切口取齣標本。全組患者術後第1天視覺模擬評分法(VAS)評分為1~3(2.0±0.6),術後排氣時間6~70(30.2±17.3) h,術後住院時間4~12(7.5±2.5) d。全組患者髮生術後皮下氣腫1例,吻閤口齣血1例,排尿睏難2例,均經保守治療好轉;1例術後第20天髮現直腸陰道瘺行迴腸造口術。隨訪期間,全組患者無腫瘤複髮及死亡。結論對于閤適的患者,taTME或聯閤腹腔鏡taTME手術是安全可行的。
목적:탐토완전경항문혹연합복강경적전직장계막절제술치료직장암적가행성여안전성。방법회고성수집2014년9월지2015년5월간우제삼군의대학대평의원행완전경항문전직장계막절제술(taTME)혹연합복강경taTME적11례직장암환자림상자료。결과전조11례환자중3례순리완성완전taTME수술,수술시간분별위210、230화215 min;8례채용복강경연합taTME수술,수술시간150~290(중위수205) min。전조무중전개복병례,단유2례환자인종류편대,이취하복부약5 cm절구취출표본。전조환자술후제1천시각모의평분법(VAS)평분위1~3(2.0±0.6),술후배기시간6~70(30.2±17.3) h,술후주원시간4~12(7.5±2.5) d。전조환자발생술후피하기종1례,문합구출혈1례,배뇨곤난2례,균경보수치료호전;1례술후제20천발현직장음도루행회장조구술。수방기간,전조환자무종류복발급사망。결론대우합괄적환자,taTME혹연합복강경taTME수술시안전가행적。
Objective To explore the feasibility and safety of transanal minimal invasive or combined laparoscopy total mesorectal excision. Methods Clinical data of 11 cases with rectal cancer undergoing transanal total mesorectal excision (taTME) in our hospital between September 2014 and May 2015 were analyzed retrospectively. Results Among 11 patients, 3 underwent pure-taTME successfully without abdominal incision and ileostomy, whose operation time was 210, 230, 215 min respectively, while other 8 patients underwent laparoscopy-assisted taTME (hybrid-taTME) with operation time ranging from 150 to 290 (median 205) min. No patient was transferred to open operation, while larger tumors of two patients were removed from hypogastric 5 cm incision. Postoperative first day V AS score was 1 to 3 (2.0±0.6), the first flatus was 6 to 70 (30.2±17.3) h, hospital stay was 4 to 12 (7.5±2.5) d, the blood loss was (104±127) ml and the liquid food intake was (28.3±6.3) h. Postoperative complications included 1 case of subcutaneous emphysema, 1 case of anastomotic stoma bleeding, 2 cases of dysuria, which were cured by conservative therapy. One patient developed rectovaginal fistula 20 days after operation and then underwent ileostomy. No relapse of tumor or death during follow-up. Conclusions For suitable rectal cancer patients, taTME or hybrid-taTME is feasible.