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目的 :探索腹腔镜全直肠系膜切除 (TME)与低位 /超低位结直肠吻合保肛门术治疗中下段直肠癌的可行性、方法与优缺点。方法 :按开放手术的TME切除原则、应用双钉合技术 ,在腹腔镜下对 12例肿瘤下缘距离肛缘 3～ 10cm的中下段直肠癌患者实施了TME与低位 /超低位结直肠吻合保肛手术 ,1例切除部分受侵犯的阴道后壁 ,1例同时行了结肠J型贮袋直肠吻合术。结果 12例患者手术顺利 ,无中转开腹 ,手术时间 190 (16 0～ 2 30 )min ;术中出血 2 0 (10～ 10 0 )ml,术后 1～ 2d恢复胃肠功能并进食流质、下床活动 ,术后住院时间 10 (6～18)d。术中术后无并发症发生。结论 :腹腔镜TME与低位 /超低位结直肠吻合保肛术治疗中下段直肠癌安全可行 ,具有创伤小、手术视野清楚、出血少、术后疼痛轻恢复快等优点。
Objective: To explore the feasibility, methods, advantages and disadvantages of laparoscopic total mesorectal excision (TME) and low/ultra-low colorectal anastomosis for anorectal repair of middle and lower rectal cancer. METHODS: TME and low/ultra-low colorectal anastomosis were performed on laparoscopically performed TME ablation of open surgery and double stapling techniques in 12 patients with lower rectum cancers located 3 to 10 cm away from the lower edge of the anal margin. In the anal operation, one patient had a partial resection of the invaded posterior vaginal wall, and one patient underwent a colonic J-type pouch rectal anastomosis. Results Twelve patients underwent successful operation without conversion to laparotomy. The operation time was 190 (16 0 - 2 30) min. The intraoperative blood loss was 2 0 (10 ~ 10 0) ml. The gastrointestinal function and fluids were restored after 1 ~ 2 days of operation. Get out of bed, postoperative hospital stay 10 (6 ~ 18) d. No complications occurred during and after surgery. Conclusion : Laparoscopic TME and low/super low colorectal anastomosis for the treatment of middle and lower rectal cancer is safe and feasible. It has the advantages of less trauma, clear surgical vision, less bleeding, and quick postoperative pain recovery.