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目的探讨腹腔镜下切除直肠间质瘤的可行性及安全性。方法 2013年5月-2016年12月在我科接受行腹腔镜直肠间质瘤切除术的患者共16例,其中男性10例、女性6例,肿瘤直径均小于5cm。肿瘤下缘距肛缘大于5cm者行腹腔镜下直肠前切除术(Dixon术),肿瘤下缘距肛缘小于5cm且大于3cm者行腹腔镜下局部切除术,肿瘤下缘距肛缘小于3cm且与周边组织界限不清者则行腹腔镜下腹会阴联合切除术(Miles术)。结果 16例直肠间质瘤患者均在腹腔镜下成功切除肿瘤,无一例中转开腹手术,无术后穿孔、出血、梗阻、吻合口漏等并发症发生。其中,12例行腹腔镜下直肠前切除术(Dixon术),3例行腹腔镜下局部切除术,1例行腹腔镜下腹会阴联合切除术(Miles术)。平均手术时间(103.0±23.8)min,平均住院时间(7.0±1.2)d,平均术中出血(14.0±4.1)mL。术后病理证实为间质瘤,切缘阴性。随访8~40个月,无一例患者复发。2例患者肿瘤转移至肝脏,并最终死于肝转移。结论腹腔镜下直肠间质瘤切除是安全、可行的,手术创伤小,住院时间短,术后恢复快。
Objective To investigate the feasibility and safety of laparoscopic resection of rectal stromal tumors. Methods A total of 16 patients underwent laparoscopic rectal stromal tumor resection in our department between May 2013 and December 2016, including 10 males and 6 females. The tumor diameters were less than 5 cm. Laparoscopic resection of the anterior rectum (Dixon’s surgery) was performed when the lower edge of the tumor was more than 5cm from the anal verge. Laparoscopic partial resection was performed with the lower edge of the tumor less than 5cm and greater than 3cm from the anal verge. The lower edge of the tumor was less than 3cm Laparoscopic peritoneal and perineal resection (Miles operation) were performed with no definite borderline with surrounding tissues. Results All the 16 patients with rectal stromal tumors underwent laparoscopic resection of the tumor. None of them underwent laparotomy, and no complications such as perforation, bleeding, obstruction and anastomotic leakage were found. Among them, 12 cases underwent laparoscopic anterior resection (Dixon), 3 underwent laparoscopic partial resection, and 1 underwent Laparoscopic perineal resection (Miles). The average operation time was (103.0 ± 23.8) min, the average length of hospital stay was (7.0 ± 1.2) d, mean intraoperative bleeding was (14.0 ± 4.1) mL. Postoperative pathology confirmed as stromal tumors, negative margins. Follow-up 8 to 40 months, no case of recurrence. Tumors metastasized to the liver in 2 patients and eventually died of liver metastases. Conclusions Laparoscopic resection of rectal stromal tumor is safe and feasible, with less trauma, shorter hospital stay and quick recovery after operation.