Objective To approach the curative effect of laparoscopic rectum resection combined with per anus intersphincteric rectal dissection and colo anal anastomosis for patients with ultra-low rectal cancer.
Methods Thirteen patients were prospectively studied from June 2005 to December 2007. There were 8 male and 5 female patients, with a mean age of 53 (range, 41-69) years. All the tumors located less than 5 cm above the anal verge. All the patients were treated with general anaesthesia and then went through the following procedures: lied the reverse Trendelenburg reforming lithotomy position, the laparoscope went inside the abdomen through two apertures, the hylus aperture (observing aperture) and the McBurney point aperture (main performing aperture). After the resection through the laparoscope, the operation was translocated to the perineal region, the anus was enlarged to expose the operation area.
Results The operation on all cases succeeded, there was no operative mortality, and no stomal leak in all patients. The follow-up duration ranged from 1 to 30 months (mean 17 months). Up to now, one patient developed recurrence in pelvic cavity, and one suffered hepatic metastasis, there was no port-site implantation metastasis， 9 patients had satisfactory functional recovery of anus in the sixth month after operation.
Conclusion The therapy laparoscopic rectum resection combined with per anus intersphincteric rectal dissection and colo-anal anastomosis for patients with ultra-low rectal cancer is a safe, minimally invasive, anal-preserving technique with reliablity in curative effect and satisfaction in anal sphincter function.
Citation：
WU Xinggui,JING Hongmin,LIN Guiheng,ZHANG Qinglin,LI Ying,WU Wanfeng. Laparoscopic Ultra-Low Anterior Rectal Resection Combined with Per Anus Intersphincteric Rectal Dissection for Ultra-Low Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(9): 656-658. doi:
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Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
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Williams NS, Patel J, George BD, et al. Development of an electrically stimulated neoanal sphincter [Ｊ]. Lancet, 1991; 338(8776)∶1166.
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Ruo L, Guillem JG. Major 20th-century advancements in the management of rectal cancer [Ｊ]. Dis Colon Rectum, 1999; 42(5)∶563.
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Rullier E, Laurent C, Bretagnol F, et al. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule [Ｊ]. Ann Surg, 2005; 241(3)∶465.
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Khler A, Athanasiadis S, Ommer A, et al. Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients [Ｊ]. Dis Colon Rectum, 2000; 43(6)∶843.
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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.
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于永扬， 杨烈， 周总光. 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.
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阚永丰, 刘军, 高志刚, 等. 经肛门括约肌间直肠切除结肠肛管吻合术作为超低位直肠癌保肛术的初步报告 [Ｊ]. 中华外科杂志， 2005; 43（9）∶573.
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丛进春， 戴显伟， 张宏. 低位直肠癌经内外括约肌间切除术后直肠肛管向量测压的研究 [Ｊ]．中国普外基础与临床杂志， 2007; 14（6）∶634.
|
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张宏， 陈春生， 丛进春. 括约肌间切除术在超低位直肠癌保肛手术中的应用 [Ｊ]. 中国普通外科杂志， 2007; 16（9）∶835.
|
| 10. |
王峰， 韩方海， 马百柱. 中低位直肠癌保留肛门括约肌手术与经腹会阴切除术的比较分析 [Ｊ]. 中国普外基础与临床杂志， 2006; 13（2）∶211.
|
| 11. |
姜金波， 戴勇， 刘涛. 超低位直肠癌内括约肌切除的根治效果及肛门功能评估 [Ｊ]. 中华普通外科杂志， 2006; 21（3）∶304.
|
| 12. |
田文， 李荣， 陈凛. 腹腔镜下直肠癌全直肠系膜切除术 [Ｊ]. 中华外科杂志， 2004; 42（3）∶911.
|
| 13. |
郑民华. 腹腔镜结直肠癌手术的原则与评价 [Ｊ]. 中华外科杂志， 2005; 43(17)∶1105.
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| 14. |
郑民华， 胡艳艳， 陆爱国. 腹腔镜与开腹直肠全系膜切除术治疗低位直肠癌的临床对比研究 [Ｊ]. 中华胃肠外科杂志， 2004; 7（3）∶177.
|
| 15. |
谢尚奎， 吴印爱， 刘献棠. 全直肠系膜切除、结肠肛管吻合术治疗低位直肠癌84例分析 [Ｊ]. 中华普通外科杂志， 2006; 21 (7)∶535.
|
| 16. |
万远廉， 潘义生. 直肠癌手术相关问题的探讨 [Ｊ]. 中华外科杂志, 2006； 44(11)∶721.
|
| 17. |
周总光， 李立， 舒晔. 腹腔镜全直肠系膜切除保肛治疗低位直肠癌 [Ｊ]. 中华外科杂志， 2002; 40（12）∶899.
|
| 18. |
郑民华. 腹腔镜低位超低位直肠癌保肛手术方式的选择 [Ｊ]. 中华胃肠外科杂志， 2007; 10（4）∶311.
|
| 19. |
郁宝铭. 重视直肠癌保肛手术的意义及其发展趋势 [Ｊ]. 中华外科杂志， 2006; 44(11)∶725.
|
| 20. |
Watanabe M, Teramoto T, Hasegawa H, et al. Laparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for lower rectal cancer [Ｊ]. Dis Colon Rectum, 2000; 43(10 Suppl)∶S94.
|
- 1. Williams NS, Patel J, George BD, et al. Development of an electrically stimulated neoanal sphincter [Ｊ]. Lancet, 1991; 338(8776)∶1166.
- 2. Ruo L, Guillem JG. Major 20th-century advancements in the management of rectal cancer [Ｊ]. Dis Colon Rectum, 1999; 42(5)∶563.
- 3. Rullier E, Laurent C, Bretagnol F, et al. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule [Ｊ]. Ann Surg, 2005; 241(3)∶465.
- 4. Khler A, Athanasiadis S, Ommer A, et al. Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients [Ｊ]. Dis Colon Rectum, 2000; 43(6)∶843.
- 5. 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.
- 6. 于永扬， 杨烈， 周总光. 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.
- 7. 阚永丰, 刘军, 高志刚, 等. 经肛门括约肌间直肠切除结肠肛管吻合术作为超低位直肠癌保肛术的初步报告 [Ｊ]. 中华外科杂志， 2005; 43（9）∶573.
- 8. 丛进春， 戴显伟， 张宏. 低位直肠癌经内外括约肌间切除术后直肠肛管向量测压的研究 [Ｊ]．中国普外基础与临床杂志， 2007; 14（6）∶634.
- 9. 张宏， 陈春生， 丛进春. 括约肌间切除术在超低位直肠癌保肛手术中的应用 [Ｊ]. 中国普通外科杂志， 2007; 16（9）∶835.
- 10. 王峰， 韩方海， 马百柱. 中低位直肠癌保留肛门括约肌手术与经腹会阴切除术的比较分析 [Ｊ]. 中国普外基础与临床杂志， 2006; 13（2）∶211.
- 11. 姜金波， 戴勇， 刘涛. 超低位直肠癌内括约肌切除的根治效果及肛门功能评估 [Ｊ]. 中华普通外科杂志， 2006; 21（3）∶304.
- 12. 田文， 李荣， 陈凛. 腹腔镜下直肠癌全直肠系膜切除术 [Ｊ]. 中华外科杂志， 2004; 42（3）∶911.
- 13. 郑民华. 腹腔镜结直肠癌手术的原则与评价 [Ｊ]. 中华外科杂志， 2005; 43(17)∶1105.
- 14. 郑民华， 胡艳艳， 陆爱国. 腹腔镜与开腹直肠全系膜切除术治疗低位直肠癌的临床对比研究 [Ｊ]. 中华胃肠外科杂志， 2004; 7（3）∶177.
- 15. 谢尚奎， 吴印爱， 刘献棠. 全直肠系膜切除、结肠肛管吻合术治疗低位直肠癌84例分析 [Ｊ]. 中华普通外科杂志， 2006; 21 (7)∶535.
- 16. 万远廉， 潘义生. 直肠癌手术相关问题的探讨 [Ｊ]. 中华外科杂志, 2006； 44(11)∶721.
- 17. 周总光， 李立， 舒晔. 腹腔镜全直肠系膜切除保肛治疗低位直肠癌 [Ｊ]. 中华外科杂志， 2002; 40（12）∶899.
- 18. 郑民华. 腹腔镜低位超低位直肠癌保肛手术方式的选择 [Ｊ]. 中华胃肠外科杂志， 2007; 10（4）∶311.
- 19. 郁宝铭. 重视直肠癌保肛手术的意义及其发展趋势 [Ｊ]. 中华外科杂志， 2006; 44(11)∶725.
- 20. Watanabe M, Teramoto T, Hasegawa H, et al. Laparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for lower rectal cancer [Ｊ]. Dis Colon Rectum, 2000; 43(10 Suppl)∶S94.
