【摘要】 目的评价腹腔镜后盆腔脏器切除术治疗局部进展期直肠癌的安全性及近期疗效,分析腹腔镜后盆腔脏器切除术操作要点。方法回顾性分析2014年4月至2019年10月由同一术者行腹腔镜后盆腔脏器切除术的15例局部进展期直肠癌患者临床资料,包括手术相关指标、病理指标和随访情况。结果 15例患者均顺利完成腹腔镜后盆腔脏器切除术(LPPE),无中转开腹病例。消化道重建方式中9例为结肠—直肠/肛管吻合,3例为乙状结肠造瘘,3例为远端直肠封闭近端乙状结肠造瘘;阴道处理方式中12例为阴道残端缝合,3例为阴道后壁切除。3例术前MRI检查提示侧方淋巴结肿大而行单侧侧方淋巴结清扫;1例联合膀胱部分切除,1例联合输尿管部分切除,1例联合右半结肠切除。平均手术时间(268.3±80.9) min,中位出血量150 (100,200) mL,平均术后住院时间(15.2±7.2) d,2例患者出现术后并发症,1例为阴道残端瘘,保守治疗3周后痊愈出院,1例为直肠吻合口漏继发直肠阴道瘘,后期遗留吻合口狭窄,至今保护性回肠造口未能还纳。全组无术后膀胱功能恢复延迟。所有手术均为R0切除,11例为癌性侵犯,8例伴区域淋巴结转移。中位随访时间2年,随访期间4例患者因肿瘤术后复发转移死亡,11例患者实现无病生存,中位生存时间25个月。结论腹腔镜后盆腔脏器切除术治疗局部进展期直肠癌安全可行,近期疗效尚可,远期肿瘤学效果仍需进一步扩大样本进行研究。更多还原

【Abstract】 Objectives To investigate the safety and short-term efficacy of laparoscopic posterior pelvic exenteration(LPPE) for locally advanced rectal cancer and to analyze the critical points of the operation. Methods This was a retrospective analysis of15 patients with locally advanced rectal cancer who were treated by the same surgeon with LPPE during April 2014 and October 2019. Information related to the surgery, pathology, and follow-up were collected. Results All LPPE was uneventful. There was no conversion to open surgery. Gastrointestinal reconstruction was performed in 9 cases with colon-rectal or colon-anal anastomosis, 3 with a permanent sigmoid colostomy, 3 with Hartmann procedure. Twelve cases were treated with vaginal stump suture, and 3 cases with resection of the posterior vaginal wall. Lateral lymphadenopathy was revealed by magnetic resonance imaging in 3 patients before surgery, and these patients underwent lateral lymph node dissection. One patient underwent PPE with partial bladder resection and repair, one patient underwent PPE with partial ureterectomy, and one patient underwent PPE with right hemicolectomy. The average operation time was(268.3±80.9) min, the median intraoperative blood loss was 150 mL(range:100～200 mL). The average postoperative hospital stay was(15.2±7.2) days. Two patients experienced postoperative complications:one had vaginal stump fistula and recovered after 3 weeks of conservative treatment. One had rectal vaginal fistula secondary to rectal anastomotic leakage, in whom protective ileostomy sustained due to secondary anastomotic stenosis. There was no delayed bladder function recovery. All operations were R0 resection. Eleven patients had cancerous invasion, and eight patients had local lymph node metastasis. The median follow-up was 2 years. Four patients died of tumor recurrence and metastasis, and 11 patients achieved disease-free survival. The median survival time was 25 months. Conclusion LPPE is safe and feasible for locally advanced rectal cancer with satisfactory short-term efficacy. Long-term oncological efficacy requires further clinical research.更多还原