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目的探讨完全经肛门全直肠系膜切除的手术操作可行性及围手术期安全性。方法自2015年5-7月,首都医科大学附属北京友谊医院普外科行完全经肛门全直肠系膜切除治疗中低位直肠癌8例。回顾性分析8例病人临床资料。结果 8例病人均顺利完成完全经肛门全直肠系膜切除,无中转腹腔镜辅助或开放手术病例。术后标本质量包括系膜完整程度、切除肠管长度(15~29 cm)、下切缘距离(1.5~3.0 cm),均符合全直肠系膜切除要求。病人术后平均住院天数为4.8(3~7)d。1例术后发生尿潴留。平均手术时间219(160~300)min。结论完全经肛门全直肠系膜切除是中低位直肠癌外科治疗的新方向,但远期效果还需更多病例及循证医学证据来验证。
Objective To investigate the feasibility of perineal total mesorectal excision and perioperative safety. Methods From May to July 2015, 8 cases of middle and low rectal cancer were completely transanal mesmectal excision with general surgery department of Beijing Friendship Hospital affiliated to Capital Medical University. The clinical data of 8 patients were retrospectively analyzed. Results All the 8 patients successfully completed the complete transanal mesorectal excision, without laparoscopic assisted or open surgery cases. The postoperative quality of the specimens included the integrity of the mesangium, the length of the excised intestine (15-29 cm) and the distance of the inferior margin (1.5-3.0 cm), all of which met the requirements of total mesorectal excision. The average postoperative hospital stay was 4.8 (3-7) days. One case of urinary retention occurred. The average operation time was 219 (160 ~ 300) min. Conclusion Complete anus and total mesorectal excision is the new direction of surgical treatment of low and middle rectal cancer. However, more long-term results need more cases and evidence-based medical evidence to verify.