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目的:分析腹腔镜超低位直肠癌根治保肛手术的疗效,以探讨腹腔镜及相关技术在超低位直肠癌根治保肛术中应用的可行性。方法:对2005年6月至2010年12月在江苏省苏北人民医院胃肠外科施行腹腔镜直肠癌前切除术中的33例超低位直肠癌患者的临床资料进行回顾性分析。结果:本研究33例患者均顺利完成手术,无中转开腹者,无手术死亡者。平均手术时间(137±43)min,平均手术切除淋巴结(5～25)枚,术中冷冻切片显示远切缘均为阴性,术后患者平均住院(9～25)d。术后发生吻合口漏3例,吻合口出血1例,肠梗阻1例。随访时间平均(23±17)个月,随访中新发现局部复发4例,远处转移4例,术后切除肿瘤种植1例,术后患者死亡7例,3年总生存率为84.4%。结论:腹腔镜超低位直肠癌根治保肛手术安全可行,可达到与传统开腹手术相同的目的和效果,并可能取得更加良好的安全性。
OBJECTIVE: To analyze the curative effect of radical anal sphincter preservation in laparoscopic ultra-low rectal cancer and to explore the feasibility of laparoscopic and related techniques in radical anal surgery for ultra-low rectal cancer. Methods: The clinical data of 33 patients with ultra-low rectal cancer undergoing laparoscopic resection of laparoscopic rectal cancer underwent gastrointestinal surgery in Jiangsu Provincial People’s Hospital of Jiangsu Province from June 2005 to December 2010 were retrospectively analyzed. Results: In this study, 33 patients completed the operation successfully, without transit laparotomy, no operative death. The average operation time was 137 ± 43 minutes and the average number of resected lymph nodes was 5-25 pieces. The frozen sections showed that the distal margin was all negative and the postoperative patients were hospitalized for an average of 9-25 days. Anastomotic leakage occurred in 3 cases, anastomotic bleeding in 1 case, 1 case of intestinal obstruction. The average follow-up time was (23 ± 17) months. In the follow-up, 4 cases of local recurrence and 4 cases of distant metastasis were found. One case was resected after operation, and 7 cases died after operation. The 3-year overall survival rate was 84.4%. Conclusion: Laparoscopic ultra-low rectal cancer is safe and feasible for anorectal surgery, which can achieve the same purpose and effect as conventional laparotomy and may achieve better safety.