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目的 探讨腹腔镜下行直肠癌全直肠系膜切除根治术的临床效果。方法 对 38例直肠腺癌患者采用腹腔镜下联合应用超声刀循盆筋膜壁层和脏层的间隙行锐性游离全直肠系膜 ,切除一个不间断的直肠整体标本 ,并对全组病例随访 2年余。结果 38例患者手术顺利 ,无中转开腹 ,术后排便、排气时间平均为 32h ,术后平均住院天数为 7 5d。术后随访至今 ,38例患者均无腹部穿刺口种植 ,其中 2例出现局部复发 ( 1例伴肝转移 )。38例患者均无排尿困难 ,6例患者有性功能减退。结论 腹腔镜下行直肠癌全直肠系膜切除术手术既能有效降低术后局部复发率和保护盆腔自主神经功能 ,又具有微创优点 ,值得临床推广。
Objective To investigate the clinical effect of total mesorectal excision in the treatment of laparoscopic rectal cancer. Methods 38 patients with rectal adenocarcinoma were treated by laparoscopic combined with ultrasonic knife through the space between the fascia parietal fascia and the visceral gut layer of sharp free total mesorectal excision, removal of an uninterrupted rectal specimen, and the whole group of patients were followed up More than 2 years. Results Thirty-eight patients underwent surgery successfully without laparotomy. The average defecation and extubation time were 32 hours and the average postoperative hospital stay was 75 days. All the 38 patients were followed up till now. No abdominal puncture was implanted in the 38 cases. Local recurrence occurred in 2 cases (one case with liver metastasis). Thirty-eight patients had no dysuria and six had sexual dysfunction. Conclusions Laparoscopic surgery for rectal cancer with total mesorectal excision can both reduce the local recurrence rate and protect pelvic autonomic nerve function effectively. It also has the advantages of minimally invasive treatment and is worthy of clinical promotion.