| 摘要: |
| ［摘要］ 目的 探讨腹腔镜外翻拖出式经括约肌间切除（ISR）联合改良Bacon术在低位直肠癌超低位保肛中的应用。方法 回顾性分析2023年3月至12月四川省肿瘤医院大肠外科采用外翻拖出式ISR联合改良Bacon术进行腹腔镜根治性切除、超低位保肛的6例低位直肠癌患者的临床资料，探讨近期临床效果，总结手术技巧。结果 6例患者均顺利完成手术，手术时间200～320 min，平均256.7 min；术中失血量20～100 mL，平均48.3 mL。术后1例患者出现外置肠段脱垂，行再次手术切除；2例患者出现外置肠段系膜局部缺血，行保守治疗后好转。所有患者均顺利恢复，术后6～11 d出院，平均术后住院时间8.2 d。所有患者均于术后21 d施行二期外置肠段切除和肛门成形术，术后3～6 d好转出院，平均术后住院时间4.3 d。随访至2024年3月，所有患者无肿瘤复发或转移，二期术后3个月Wexner肛门失禁评分1～5分，平均3.2分，肛门控便功能满意。结论 腹腔镜外翻拖出式ISR联合改良Bacon术有助于实现肿瘤远端的精准切除，能极大降低经肛切除的操作难度，而且避免了预防性肠造口，术后肛门功能满意，有望成为低位直肠癌行超低位保肛手术的新选择。 |
| 关键词: 低位直肠癌 腹腔镜 经括约肌间切除 改良Bacon术 超低位保肛 |
| DOI：10.3969/j.issn.1674-3806.2024.05.03 |
| 分类号:R 735.3+7 |
| 基金项目: |
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| Application of laparoscopic intersphincteric resection by transanal specimen eversion combined with modified Bacon operation in ultra-low anal preservation for lower rectal cancer(report of 6 cases) |
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LI Jiaze1,2, WANG Wuyi2, RUI Yuanyi2, YI Bo2, CHEN Chao2, FENG Xiaopei2, ZHANG Jingbo2, ZHENG Yangchun1,2
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1.School of Medicine, University of Electronic Science and Technology of China, Chengdu 610054, China; 2.Department of Colorectal Surgery, Sichuan Cancer Hospital, Chengdu 610041, China
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| Abstract: |
| ［Abstract］ Objective To explore the application of laparoscopic intersphincteric resection(ISR) by transanal specimen eversion combined with modified Bacon operation in ultra-low anal preservation for lower rectal cancer. Methods The clinical data of 6 cases with lower rectal cancer who underwent laparoscopic radical resection and ultra-low anal preservation with ISR by transanal specimen eversion combined with modified Bacon operation in the Department of Colorectal Surgery of Sichuan Cancer Hospital from March 2023 to December 2023 were retrospectively analyzed. The short-term clinical effects were explored and the surgical skills were summarized. Results All the operations were accomplished successfully in the 6 patients, with operation durations ranging from 200 to 320 minutes and an average duration of 256.7 minutes. Intraoperative blood loss ranged from 20 to 100 milliliters, with an average blood loss of 48.3 milliliters. After operation, 1 patient developed prolapse of the external intestinal segment and underwent reoperation for resection, and 2 patients developed local mesenteric ischemia of the external intestinal segment and improved after conservative treatment. All the patients recovered successfully and were discharged from the hospital 6 to 11 days after operation, with an average postoperative hospital stay of 8.2 days. All the patients underwent second-stage external intestinal segment resection and anoplasty 21 days after surgery, and were discharged from the hospital 3 to 6 days after operation, with an average postoperative hospital stay of 4.3 days. All the patients were followed up until March 2024, and no tumor recurrence and metastasis were observed, and Wexner incontinence scores ranged from 1 to 5 points 3 months after the second-stage operation with average scores of 3.2 points, and the anal continence function was satisfactory. Conclusion Laparoscopic ISR by transanal specimen eversion combined with modified Bacon operation can help to achieve accurate resection of distal tumors, can greatly reduce the operational difficulty of transanal resection and avoid preventive enterostomy, and the postoperative anal function is satisfactory, which is expected to become a new choice for ultra-low anal preservation surgery for lower rectal cancer. |
| Key words: Lower rectal cancer Laparoscopy Intersphincteric resection(ISR) Modified Bacon operation Ultra-low anal preservation |
