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目的:探讨腹腔镜联合经肛门拖出适形切除术治疗极低位直肠癌的手术安全性、可行性和经验体会。方法:2013年6月至2014年6月对8例符合Rullier极低位直肠癌外科学分类标准中Ⅱ、Ⅲ型病人施行腹腔镜联合经肛门拖出适形切除术。结果:本研究8例病人均在腹腔镜下完成切除手术,平均手术时间为(168.4±27.3)min,术中出血量(47.0±13.0)m L,远切缘距离(0.6±0.3)cm,肠系膜淋巴结(14.9±2.8)枚。1例术后发生骶前感染,经抗感染及引流后治愈。术后随访未发现肿瘤局部复发及远处转移病人,3例回肠造口还纳术后病人肛门功能良好。结论:治疗极低位直肠癌的腹腔镜联合经肛门拖出适形切除术是一种极限位保肛技术,决定能否保肛的最重要因素不是肿瘤与齿线距离,而是肿瘤对肛管直肠环的侵犯及类型。
Objective: To investigate the safety, feasibility and experience of laparoscopic surgery combined with anal resection for treatment of very low rectal cancer. Methods: From June 2013 to June 2014, 8 patients undergoing Rullier minimal rectal cancer classification of type II and III underwent laparoscopic combined anus draining and conformal resection. Results: All the 8 patients underwent laparoscopic resection. The mean operative time was (168.4 ± 27.3) min, blood loss (47.0 ± 13.0) m L, distance distal margin (0.6 ± 0.3) cm, Mesenteric lymph nodes (14.9 ± 2.8) pieces. One case had presacral infection and was cured after anti-infection and drainage. Postoperative follow-up found no local tumor recurrence and distant metastasis patients, 3 cases of ileostomy surgery satisfied patients with anal function well. Conclusion: The treatment of very low rectal cancer with laparoscopic transanal pull out of the conformal resection is a limit bit anus retention technology, the decision whether the most important factor to protect the anus is not the tumor and tooth line distance, but the tumor to anal Rectal ring violations and types.