腹腔镜直肠癌根治经肛门切除标本套入式吻合术的临床疗效
복강경직장암근치경항문절제표본투입식문합술적림상료효
Clinical efficacy of laparoscopic radical resection for rectal cancer using transanal telescopic anastomosis
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    Chinese Journal of Digestive Surgery
    2015年 11期 930-934 ,共5页

    李世拥%陈纲%杜峻峰%崔伟%陈光%于波%季锡清%袁强

    리세옹%진강%두준봉%최위%진광%우파%계석청%원강

    直肠肿瘤%根治术%套入式吻合术%腹腔镜检查 直腸腫瘤%根治術%套入式吻閤術%腹腔鏡檢查
    직장종류%근치술%투입식문합술%복강경검사
    Rectal neoplasms%Radical resection%Telescopic anastomosis%Laparoscopy
    目的 探讨腹腔镜直肠癌根治经肛门切除标本套入式吻合术的临床疗效.方法 回顾性分析2010年3月至2014年12月北京军区总医院收治的52例低位直肠癌患者的临床资料.患者行腹腔镜直肠癌根治经肛门切除标本套入式吻合术.术后对T2N1期以上患者行常规化疗.疗效评价指标包括:手术时间、术中出血量、淋巴结检出数目、术后肛门排气时间、盆腔引流管拔除时间、术后住院时间、术后并发症、切缘情况、术后肛门排便功能、肿瘤局部复发情况.采用门诊、住院和电话方式进行随访,随访内容包括并发症发生情况、术后肛门排便功能及肿瘤局部复发情况,随访时间截至2015年3月.正态分布的计量资料以-x±s表示,偏态分布的计量资料以M(范围)表示.结果 52例患者均成功行经肛门切除标本的套入式吻合保肛腹腔镜低位直肠癌根治术;手术时间为(150±36) min,术中出血量为(16 ±9)mL,淋巴结检出数目为(12±9)枚,术后肛门排气时间为(2.0±1.5)d,盆腔引流管拔除时间为(5.0±2.0)d,术后住院时间为(9.0±2.5)d.术后发生吻合口瘘1例,予横结肠造口,3个月后还纳愈合良好.术后病理学检查结果:高中分化腺癌46例,低分化腺癌6例;TNM分期:T1 ～ 2N0M0期29例,T2N1 ～ 2M0期23例;肿瘤下切缘和环周切缘均为阴性.52例患者术后早期进食后排便次数为6～9次/d,予复方苯乙哌啶片2片/次口服,3次/d,服药后2～3d排便次数可控制在3～6次/d.术后23例T2N1期以上患者行常规化疗.52例患者术后均获得随访,中位随访时间为29.7个月(3.0～51.0个月).术后2～3个月排便自控能力明显改善.术后12个月肛门排便功能Kirwan 1级占94.2％(49/52),肛门排便功能基本恢复正常.其余3例患者均为Kirwan 2级.随访期间,1例患者发生吻合口狭窄,经扩肛治疗后缓解.无患者发生肿瘤局部复发,患者生命质量均良好.结论 腹腔镜直肠癌根治经肛门切除标本套入式吻合术安全有效,腹部无切口,美容效果好,近期临床疗效满意.
    목적 탐토복강경직장암근치경항문절제표본투입식문합술적림상료효.방법 회고성분석2010년3월지2014년12월북경군구총의원수치적52례저위직장암환자적림상자료.환자행복강경직장암근치경항문절제표본투입식문합술.술후대T2N1기이상환자행상규화료.료효평개지표포괄:수술시간、술중출혈량、림파결검출수목、술후항문배기시간、분강인류관발제시간、술후주원시간、술후병발증、절연정황、술후항문배편공능、종류국부복발정황.채용문진、주원화전화방식진행수방,수방내용포괄병발증발생정황、술후항문배편공능급종류국부복발정황,수방시간절지2015년3월.정태분포적계량자료이-x±s표시,편태분포적계량자료이M(범위)표시.결과 52례환자균성공행경항문절제표본적투입식문합보항복강경저위직장암근치술;수술시간위(150±36) min,술중출혈량위(16 ±9)mL,림파결검출수목위(12±9)매,술후항문배기시간위(2.0±1.5)d,분강인류관발제시간위(5.0±2.0)d,술후주원시간위(9.0±2.5)d.술후발생문합구루1례,여횡결장조구,3개월후환납유합량호.술후병이학검사결과:고중분화선암46례,저분화선암6례;TNM분기:T1 ～ 2N0M0기29례,T2N1 ～ 2M0기23례;종류하절연화배주절연균위음성.52례환자술후조기진식후배편차수위6～9차/d,여복방분을고정편2편/차구복,3차/d,복약후2～3d배편차수가공제재3～6차/d.술후23례T2N1기이상환자행상규화료.52례환자술후균획득수방,중위수방시간위29.7개월(3.0～51.0개월).술후2～3개월배편자공능력명현개선.술후12개월항문배편공능Kirwan 1급점94.2％(49/52),항문배편공능기본회복정상.기여3례환자균위Kirwan 2급.수방기간,1례환자발생문합구협착,경확항치료후완해.무환자발생종류국부복발,환자생명질량균량호.결론 복강경직장암근치경항문절제표본투입식문합술안전유효,복부무절구,미용효과호,근기림상료효만의.
    Objective To investigate the clinical efficacy of laparoscopic radical resection for rectal cancer using transanal telescopic anastomosis.Methods The clinical data of 52 patients with low rectal cancer who underwent laparoscopic radical resection using transanal telescopic anastomosis at the General Hospital of Beijing Military Command from March 2010 to December 2014 were retrospectively analyzed.Patients with T2N1 stage received the routine chemotherapy after operation.The evaluating indexes of clinical efficacy included operation time, volume of intraoperative blood loss, number of lymph nodes dissection, time to anal exsufflation, pelvic drainage-tube removal time, duration of hospital stay, postoperative complications, marginal states, postoperative anal defecation function and local recurrence of tumors.Patients were followed up by outpatient and inpatient examinations and telephone interview up to March 2015, and follow-up included the occurrence of complications, postoperative anal defecation function and local recurrence of tumors.Measurement data with normal distribution were presented as-x ± s, and measurement data with skew distribution were described as M (range).Results Fifth-two patients underwent transanal laparoscopic sphincter-preserving radical resection using telescopic anastomosis successfully.The operation time, volume of intraoperative blood loss, number of lymph nodes dissection, time to anal exsufflation, pelvic drainage-tube removal time and duration of hospital stay were (150 ±36) minutes, (16 ± 9) mL, 12 ± 9, (2.0 ± 1.5) days, (5.0 ± 2.0) days and (9.0 ± 2.5) days, respectively.One patient with anastomotic fistula was cured by transverse colostomy, with a stoma healing 3 months later.The postoperative pathological examination showed there were 46 patients with high-and moderate-differentiated adenocarcinomas and 6 patients with poor-differentiated adenocarcinomas, and T1-2N0M0 stage was detected in 29 patients and T2N1-2M0 stage in 23 patients.The distal and circumferential resection margins of tumors were negative.The defecation of 6-9 times/day in 52 patients after postoperative early food intake was reduced to 3-6 times/day after taking orally compound diphenoxylate tablets 2 pills each time and 3 times a day for 2-3 days.Twenty-three patients with T2N1 stage or above underwent postoperative routine chemotherapy.Fifth-two patients were followed up for a median time of 29.7 months (range, 3.0-51.0 months).The defecation control was improved remarkably at 2-3 months after operation.There was 94.2％ (49/52) of patients with Kirwan grade lof anal defecation function at postoperative month 12, and anal defecation function had basically returned to normal.There were 3 patients with Kirwan grade 2 of anal defecation function.One patient complicated with anastomotic stenosis had remission by anal expansion treatment during follow-up.Patients had no local recurrence of tumor with good quality of life.Conclusion Laparoscopic radical resection for low rectal cancer using transanal telescopic anastomosis is safe and feasible without abdominal incision, with a good cosmetic effect and satisfactory short-term outcome.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문