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目的手辅助腹腔镜为通过腹壁小切口放入术者手的入路装置,术者的手配合器械进行操作。本文介绍HALS下低位直肠癌保肛手术的经验和近期临床效果。方法介绍2010年1月至2012年1月对49例直肠癌用HALS技术完成低位、超低位前切除术,肿瘤下缘距离肛缘5 cm以内17例、大于或等于5 cm的32例,男28例、女21例,术前影像学评估无盆腔侧部淋巴结转移和远隔脏器转移,介绍手术操作技术和术后近期临床效果。结果无中转开腹,其中低位前切除27例,超低位前切除22例。R0切除46例,R1切除3例,平均手术时间为(128.27±70.89)min,术后肉眼评估全直肠系膜切除完整为42例,接近完整为7例。平均取材淋巴结总数为(16.20±9.23)个,平均转移淋巴结个数为(1.12±2.19)个,TNM分期(NCCN2009年)Ⅰ期12例;ⅡA期18例;ⅡB期1例;ⅢA期2例;ⅢB期8例;ⅢC期5例;Ⅳ期3例。术后住院时间为(6.25±3.87)d,引流管置放时间为3～7 d,平均为(4.87±2.34)d。未发生吻合口漏和术后肠梗阻。结论 HALS下直肠癌低位、超低位前切除术技术上是安全和可行的,近期效果良好。
Objective Hand-assisted laparoscopy is an access device that is placed into the operator’s hand through a small incision in the abdominal wall. The operator’s hand is operated in conjunction with the device. This article describes the experience and recent clinical results of sphincter preserving surgery for low rectal cancer under HALS. METHODS: From January 2010 to January 2012, 49 patients with rectal cancer underwent low-level, ultra-low anterior resection with HALS technique. The lower edge of the tumor was within 5 cm of the anal rim, and 17 cases were greater than or equal to 5 cm. In 28 patients and 21 women, no preoperative angiography assessed pelvic lateral lymph node metastasis and distant visceral metastasis. The surgical technique and immediate postoperative clinical effects were described. Results There was no conversion to laparotomy, of which 27 cases were performed with low anterior resection and 22 cases with ultralow anterior resection. R0 resection in 46 cases, R1 resection in 3 cases, the average operation time was (128.27 ± 70.89) min, postoperative visual assessment of total mesorectal complete 42 cases, nearly complete in 7 cases. The average number of lymph nodes obtained was (16.20±9.23), the average number of metastatic lymph nodes was (1.12±2.19), TNM staging (NCCN2009) was 12 in phase I, IIA was in 18 patients, IIB was in 1 patient, and IIIA was in 2 patients There were 8 cases in stage IIIB, 5 cases in stage IIIC, and 3 cases in stage IV. The postoperative hospital stay was (6.25±3.87) days, and drainage tube placement time was 3-7 days, with an average of (4.87±2.34) days. Anastomotic leakage and postoperative intestinal obstruction did not occur. Conclusion The low and ultra-low anterior resection of rectal cancer under HALS is safe and feasible. The recent results are good.