Objective To investigate the feasibility of laparoscopic-assisted transanal everted pull-through resection and anastomosis in the treatment for ultra-low rectal cancer (the inferior margin of the tumor from the anal margin of less than 5cm).
Methods From December 2006 to December 2009,46 patients with ultra-low rectal cancer had been undergone laparoscopic-assisted transanal everted pull-through resection and anastomosis. The intraoperative condition,postoperative complications,and the result of follow-up were analyzed retrospectively.
Results The operation was successfully performed on all the patients. The intraoperative blood loss was (202±56) ml (100-290m1). The time of recovery of gastrointestinal function was (60±16) h (36-82 h). No anastomotic bleeding or stomal leak was observed. All the patients were followed-up for (31±5) months (21-45months),15 patients developed mild to moderate anastomotic stricture,1 local recurrence, and 2 liver metastasis. All the patients had no anal incontinence 10months after stoma closure operation, the defecation of all the patients became normal (4.5±1.2) months(2-10months) later.
Conclusions Laparoscopic-assisted transanal everted pull-through resection and anastomosis for ultra-low rectal cancer is safe and feasible, and the effect is satisfactory.
Citation:
ZHU Jun,DING Jianhua,ZHAO Ke,TANG Haiyan,ZHANG Bin,ZHAO Yong,YIN Shuhui,LIU Shengnan,.. Clinical Analysis of Laparoscopic-Assisted Transanal Everted Pull-Through Resection and Anastomosis for Ultra-Low Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(5): 530-533. doi:
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郑民华. 腹腔镜结直肠癌手术的应用现状与进展 [J]. 中华消化外科杂志, 2008, 7(3):164-166.
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陆培华, 陶国清, 沈伟, 等. 国内腹腔镜结直肠癌切除术根治效果的Meta 分析 [J]. 中华消化外科杂志, 2008, 7(6):458-460.
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Kirwan WO, Turnbull RB Jr, Fazio VW, et a1. Pullthrough operation with delayed anastomosis for rectal cancer [J]. Br J Surg, 1978, 65(10):695-698.
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顾晋. 低位直肠癌外科手术 [J]. 肿瘤学杂志, 2006, 12(1):27-30.
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7. |
韩加刚, 王振军, 魏广辉. 肛门内括约肌切除术治疗T1-2 期超低位直肠癌的疗效评价 [J]. 中华胃肠外科杂志, 2010, 13(4):256-259.
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李立. 结直肠癌外科应用技术的规范与创新( 十五) [J]. 中国普外基础与临床杂志, 2008, 15(3):215-217.
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9. |
Law WL, Lee YM, Choi HK, et a1. Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival [J]. Ann Surg, 2007, 245(1):1-7.
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10. |
Fukunaga Y, Higashino M, Tanimura S, et a1. Laparoscopic rectal surgery for middle and lower rectal cancer [J]. Surg Endosc, 2010 , 24(1):145-151.
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(5):462-464.
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12. |
于永扬, 杨烈, 周总光, 等. 腹腔镜全直肠系膜切除保肛术后生活质量评估 [J]. 中国普外基础与临床杂志, 2007, 14(5):524-529.
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汪建平. 重视结直肠癌外科手术患者术后生存质量的提高 [J]. 中国普外基础与临床杂志, 2007, 14(6):625-627.
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14. |
郑民华. 腹腔镜结直肠癌手术的现状和未来 [J] . 肿瘤学杂志, 2009, 15(2):98-100.
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15. |
涂建成, 李建伟, 方健, 等. 腹腔镜辅助下低位直肠癌根治术21例体会 [J]. 中国普外基础与临床杂志, 2009, 16(10):812-813.
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Veldkamp R, Kuhry E, Hop WC, et a1. Laparoscopic surgery versus open surgery for colon cancer:short-term outcomes of a randomised trial [J]. Lancet Oncol, 2005, 6(7):477-484.
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17. |
Nelson H, Petrelli N, Carlin A,et a1. Guidelines 2000 for colon and rectal cancer surgery [J]. J Natl Cancer Inst, 2001, 93(8):583-596.
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18. |
张卫, 傅传刚. 低位直肠癌治疗进展 [J]. 国际外科学杂志,2008, 35(11):721-723.
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19. |
梁国健, 洪楚原, 陈德, 等. 超低位直肠癌腹腔镜辅助下经肛门拖出吻合术( 附21 例报告) [J]. 腹部外科, 2008, 21(1):22-23.
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Fukunaga M, Kidokoro A, Iba T, et a1. Laparoscopy-assisted low anterior resection with a prolapsing technique for low rectal cancer [J]. Surg Today, 2005, 35(7):598-602.
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Prete F, Prete FP, De Luca R, et a1. Restorative proctectomy with colon pouch-anal anastomosis by laparoscopic transanal pullthrough:an available option for low rectal cancer? [J]. Surg Endosc, 2007, 21(1):91-96.
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Fukunaga Y, Higashino M, Tanimura S, et a1. New technique for rectal division in laparoscopic anterior resection [J]. World J Surg, 2008, 32(9):2095-2100.
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郁宝铭. 结直肠癌外科治疗的现状和展望 [J]. 中国普外基础与临床杂志, 2008, 15(9):631-636.
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24. |
费伯健, 金留根, 曹华祥. 外翻切除吻合技术在腹腔镜直肠癌根治术中的应用 [J]. 肿瘤, 2010, 30(1):85-86.
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Constantinides VA, Cheetham D, Nicholls RJ, et a1. Is rectal washout effective for preventing localized recurrence after anterior resection for rectal cancer? [J]. Dis Colon Rectum, 2008, 51(9):1339-1344.
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26. |
Taflampas P, Christodoulakis M, Tsiftsis DD. Anastomotic leakage after low anterior resection for rectal cancer:facts,obscurity, and fiction [J]. Surg Today, 2009, 39(3):183-188.
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Eriksen MT, Wibe A, Norstein J, et a1. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients [J]. Colorectal Dis, 2005, 7(1):51-57.
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- 1. 郑民华. 腹腔镜结直肠癌手术的应用现状与进展 [J]. 中华消化外科杂志, 2008, 7(3):164-166.
- 2. 陆培华, 陶国清, 沈伟, 等. 国内腹腔镜结直肠癌切除术根治效果的Meta 分析 [J]. 中华消化外科杂志, 2008, 7(6):458-460.
- 3. 吴孟超, 吴在德. 黄家驷外科学 [M]. 第7 版. 北京:人民卫生出版社, 2008:1562-1563.
- 4. 中国抗癌协会大肠癌专业委员会腹腔镜外科学组, 中华医学会外科分会腹腔镜与内镜外科学组. 腹腔镜结肠直肠癌根治性手术操作指南(2006 版) [J]. 外科理论与实践, 2006,.
- 5. Kirwan WO, Turnbull RB Jr, Fazio VW, et a1. Pullthrough operation with delayed anastomosis for rectal cancer [J]. Br J Surg, 1978, 65(10):695-698.
- 6. 顾晋. 低位直肠癌外科手术 [J]. 肿瘤学杂志, 2006, 12(1):27-30.
- 7. 韩加刚, 王振军, 魏广辉. 肛门内括约肌切除术治疗T1-2 期超低位直肠癌的疗效评价 [J]. 中华胃肠外科杂志, 2010, 13(4):256-259.
- 8. 李立. 结直肠癌外科应用技术的规范与创新( 十五) [J]. 中国普外基础与临床杂志, 2008, 15(3):215-217.
- 9. Law WL, Lee YM, Choi HK, et a1. Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival [J]. Ann Surg, 2007, 245(1):1-7.
- 10. Fukunaga Y, Higashino M, Tanimura S, et a1. Laparoscopic rectal surgery for middle and lower rectal cancer [J]. Surg Endosc, 2010 , 24(1):145-151.
- 11. (5):462-464.
- 12. 于永扬, 杨烈, 周总光, 等. 腹腔镜全直肠系膜切除保肛术后生活质量评估 [J]. 中国普外基础与临床杂志, 2007, 14(5):524-529.
- 13. 汪建平. 重视结直肠癌外科手术患者术后生存质量的提高 [J]. 中国普外基础与临床杂志, 2007, 14(6):625-627.
- 14. 郑民华. 腹腔镜结直肠癌手术的现状和未来 [J] . 肿瘤学杂志, 2009, 15(2):98-100.
- 15. 涂建成, 李建伟, 方健, 等. 腹腔镜辅助下低位直肠癌根治术21例体会 [J]. 中国普外基础与临床杂志, 2009, 16(10):812-813.
- 16. Veldkamp R, Kuhry E, Hop WC, et a1. Laparoscopic surgery versus open surgery for colon cancer:short-term outcomes of a randomised trial [J]. Lancet Oncol, 2005, 6(7):477-484.
- 17. Nelson H, Petrelli N, Carlin A,et a1. Guidelines 2000 for colon and rectal cancer surgery [J]. J Natl Cancer Inst, 2001, 93(8):583-596.
- 18. 张卫, 傅传刚. 低位直肠癌治疗进展 [J]. 国际外科学杂志,2008, 35(11):721-723.
- 19. 梁国健, 洪楚原, 陈德, 等. 超低位直肠癌腹腔镜辅助下经肛门拖出吻合术( 附21 例报告) [J]. 腹部外科, 2008, 21(1):22-23.
- 20. Fukunaga M, Kidokoro A, Iba T, et a1. Laparoscopy-assisted low anterior resection with a prolapsing technique for low rectal cancer [J]. Surg Today, 2005, 35(7):598-602.
- 21. Prete F, Prete FP, De Luca R, et a1. Restorative proctectomy with colon pouch-anal anastomosis by laparoscopic transanal pullthrough:an available option for low rectal cancer? [J]. Surg Endosc, 2007, 21(1):91-96.
- 22. Fukunaga Y, Higashino M, Tanimura S, et a1. New technique for rectal division in laparoscopic anterior resection [J]. World J Surg, 2008, 32(9):2095-2100.
- 23. 郁宝铭. 结直肠癌外科治疗的现状和展望 [J]. 中国普外基础与临床杂志, 2008, 15(9):631-636.
- 24. 费伯健, 金留根, 曹华祥. 外翻切除吻合技术在腹腔镜直肠癌根治术中的应用 [J]. 肿瘤, 2010, 30(1):85-86.
- 25. Constantinides VA, Cheetham D, Nicholls RJ, et a1. Is rectal washout effective for preventing localized recurrence after anterior resection for rectal cancer? [J]. Dis Colon Rectum, 2008, 51(9):1339-1344.
- 26. Taflampas P, Christodoulakis M, Tsiftsis DD. Anastomotic leakage after low anterior resection for rectal cancer:facts,obscurity, and fiction [J]. Surg Today, 2009, 39(3):183-188.
- 27. Eriksen MT, Wibe A, Norstein J, et a1. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients [J]. Colorectal Dis, 2005, 7(1):51-57.