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[目的]探讨腹腔镜直肠癌全直肠系膜切除(TME)手术几个值得注意的问题。[方法]回顾性分析腹腔镜直肠癌TME手术65例。[结果]65例按TME原则采用腹腔镜完成直肠癌手术,Dixon手术58.5%(38/65),Miles手术30.8%(20/65),Parks手术10.8%(7/65)。手术时间130～300min,平均175min,术中平均出血量120ml。本组无吻合口瘘,无围手术期死亡病例。术后1～4d肠道功能恢复。[结论]腹腔镜直肠癌TME手术安全可行,术中应根据病情选择肠系膜下动脉切断位置、盆腔自主神经保留以及是否行保护性回肠造口。
[Objective] To discuss several noteworthy problems of total mesorectal excision (TME) surgery of laparoscopic rectal cancer. [Methods] A retrospective analysis of 65 cases of laparoscopic TME surgery for rectal cancer. [Results] 65 cases were treated by laparoscopy according to the principle of TME. 58.5% (38/65) of Dixon operations, 30.8% (20/65) of Miles operations and 10.8% (7/65) of Parks operations were performed. The operation time was 130 ~ 300min with an average of 175min. The average blood loss during operation was 120ml. This group no anastomotic leakage, no perioperative deaths. Intestinal function recovered 1 ~ 4 days after operation. [Conclusion] TME of laparoscopic rectal cancer is safe and feasible. The location of inferior mesenteric artery, pelvic autonomic nerve preservation and protective ileostomy should be selected according to the disease.