【摘要】 目的:通过技术改进和经验积累,在不降低安全性、有效性和微创性的基础上,探讨扩大腹腔镜直肠癌根治手术的适用范围。方法:4～5孔法实施手术,术中根据肿瘤位置和大小,确定系膜保留位置,为术后盆壁腹膜化重建做好准备,按照标准的直肠全系膜切除手术要求,循解剖间隙实施手术。系膜血管采用解剖性游离然后结扎切断和提出腹腔处理两种方法。为了解决手术范围狭小的问题,充分显露腹膜返折及以下盆腔空间,腹腔镜下使用五叶拉钩,较好的解决了空间不利于显露的缺点。消化道的重建采用完全腹腔镜手术、腹腔镜辅助手术、肛门拖出吻合器吻合以及人工吻合等方法。盆底腹膜主要用连续缝合关闭,部分采用腹膜整形大部分关闭,少量采用完全不关闭等方法。结果:全组62例,57例手术成功,1例直肠中动脉出血,4例晚期肿瘤侵犯周围脏器中转开腹。手术时间平均175min,术中出血量平均70mL,术后住院时间平均9d,无严重并发症。全组患者随访3～36个月,平均15个月,失访率5%,1年生存率91%,3年生存率76%,6例拖出式吻合患者大便次数较多,6～9个月后好转。结论:经过技术改进,腹腔镜直肠癌切除手术可以被更广泛的应用。更多还原

【Abstract】 Objective: To assess the reliability of laparoscopic anterior resection (LAR) for rectal cancer. Methods: The clinical data of 62 patients were reviewed retrospectively after anterior resection for rectal adenocarcinoma performed by minimal access. Results: LAR was performed successfully in 57 patients, and conversion to laparotomy was required in 5 cases. Mean operationtime for nonconverted patients was 175 min. The mean length of hospital stay (LOS) was 9 days. The local relapse occurred in 6 cases. Conclusion: The outcomes of this study suggest that LAR for rectal cancer is a reliable procedure.更多还原