论文部分内容阅读
目的探讨腹腔镜下直肠癌全直肠系膜切除(totalmesorectalexcision,TME)手术的可行性。方法自2000年3月至2003年11月共行腹腔镜下直肠癌TME手术67例,其中直肠癌前切除术(anteriorresection,AR)45例,直肠癌腹会阴联合切除术(abdominalperinealresection,APR)22例。结果本组67例患者按TME原则采用腹腔镜完成直肠癌手术,术中出血量10～50ml,手术时间2.5～5.0h,无术中死亡,术后持续胃肠减压时间8～24h,平均术后24～48h开始进食水,术后1～3d下床活动,术后1～5d开始排便。术后住院时间7～10d。术后随访时间3～43个月,2例患者局部复发,2例患者肝转移;术后因局部复发和肝转移各死亡1例,失访3例;有19例术后不足1年的患者,未发现转移及复发。结论只要有较好的开腹TME手术经验和腹腔镜操作技能,腹腔镜下直肠癌TME手术是可行的。
Objective To investigate the feasibility of laparoscopic total mesorectal excision (TME) for rectal cancer. Methods From March 2000 to November 2003, 67 cases of TME underwent laparoscopic resection of rectal cancer, including 45 cases of anterior resection (AR), 22 cases of rectal cancer with abdominal perineal rection (APR) example. Results The group of 67 patients underwent laparoscopy according to the principle of TME to complete the operation of rectal cancer. The blood loss was 10 ~ 50ml and the operation time was 2.5 ~ 5.0h. There was no intraoperative death and the duration of postoperative gastrointestinal decompression was 8 ~ 24h. The mean After 24 ~ 48h began to eat water, bed activity after 1 ~ 3d, postoperative 1 ~ 5d began defecation. Postoperative hospital stay 7 ~ 10d. The patients were followed up for 3 to 43 months. Two patients had local recurrence and two patients had liver metastasis. One patient died of local recurrence and liver metastasis after operation, and three patients lost follow-up. Nineteen patients with less than one year after operation , Did not find the transfer and recurrence. Conclusion As long as there is a good experience of laparoscopic TME operation and laparoscopic operation skills, laparoscopic TME surgery of rectal cancer is feasible.