Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer
Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer
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DOI：
10.1002/bjs.4052
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发表时间：
2003-04-01
影响因子：
9.6
通讯作者：
Saric, J
中科院分区：
文献类型：
--
作者：
Rullier, E;Sa Cunha, A;Saric, J
背景：从直肠系膜切除质量、保留盆神经自主神经和保留肛门括约肌等方面对中低位直肠癌患者行腹腔镜直肠切除术的可行性进行前瞻性研究。方法：对32例(21例)距肛缘5 cm的直肠癌患者施行腹腔镜直肠切除术。大多数患者有T3病变，术前接受放射治疗。放疗后6周行全直肠系膜切除、括约肌间切除、经肛门结肠直肠吻合术和回肠环形造口术。术后并发症10例，主要与结肠成形术有关。宏观评估显示，32个切除标本中有29个完整地切除了直肠系膜；显微镜下，32个切除标本中有30个是R0。31例保留括约肌。在32例患者中，有24例明确并保留了腹下神经和盆丛。18名可评价的男性中有10名保留了性功能。结论：大多数中低位直肠癌患者可以考虑采用腹腔镜手术。
Background: The feasibility of laparoscopic rectal resection in patients with mid or low rectal cancer was studied prospectively with regard to quality of mesorectal excision, autonomic pelvic nerve preservation and anal sphincter preservation.Methods: Laparoscopic rectal excision was performed in 32 patients (21 men) with rectal carcinoma located 5 cm from the anal verge. Most patients had T3 disease and received preoperative radiotherapy. The surgical procedure was performed 6 weeks after radiotherapy and included total mesorectal excision, intersphincteric resection, transanal coloanal anastomosis with coloplasty and loop ileostomy.Results: Three patients needed conversion to a laparotomy. Postoperative morbidity occurred in ten patients, related mainly to coloplasty. Macroscopic evaluation showed an intact mesorectal excision in 29 of 32 excised specimens; microscopically, 30 of the 32 resections were R0. Sphincter preservation was achieved in 31 patients. The hypogastric nerves and pelvic plexuses were identified and preserved in 24 of the 32 patients. Sexual function was preserved in ten of 18 evaluable men.Conclusion: A laparoscopic approach can be considered in most patients with mid or low rectal cancer.