腹腔鏡直腸癌根治手術路徑的規范化及應用前景：附433例報道_《中國普外基礎與臨床雜志》

作者：

童衛東 ¹ , 高羽 ¹ , 張安平 ¹ , 李春穴 ¹ , 張連陽 ² , 王李 ¹ , 李凡 ¹ , 趙松 ¹ , 劉寶華 ¹

1.第三軍醫大學大坪醫院胃結直腸外科（重慶400042）;;
2.第三軍醫大學大坪醫院創傷外科（重慶400042）;

關鍵詞：

直腸癌腹腔鏡手術規范化手術

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目的探討腹腔鏡直腸癌根治術的手術路徑及應用前景。方法回顧性分析我院2003年7月至2010年12月期間行腹腔鏡直腸癌根治術的433例患者的臨床資料，結合文獻復習，討論腹腔鏡直腸癌根治手術的路徑選擇及發展前景。結果行手助腹腔鏡手術5例（1.2%），完全腹腔鏡手術（Dixon手術需做左下腹小切口取出標本，Miles手術利用會陰切口取出標本）412例(95.2%)，腹部免切口肛門拖出式吻合手術16例(3.7%)。中轉開腹手術11例（2.5%）。 290例（67.0%）患者獲得隨訪，隨訪時間1～6 年，平均27年,發現吻合口或盆腔腫瘤復發7例（2.4%），遠處轉移22例（7.6%），死亡46例（15.9%），無戳孔轉移發生。結論四孔腹腔鏡技術仍是臨床應用的主流；規范化的腹腔鏡直腸癌根治術是保證療效和操作便利的前提；單孔或經自然腔道的直腸癌根治術是手術進一步微創化的探索方向。

引用本文： 童衛東,高羽,張安平,李春穴,張連陽,王李,李凡,趙松,劉寶華. 腹腔鏡直腸癌根治手術路徑的規范化及應用前景：附433例報道. 中國普外基礎與臨床雜志, 2011, 18(11): 1151-1154. doi: 復制

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12.	Laurent C, Leblanc F, Gineste C, et al. Laparoscopic approach in surgical treatment of rectal cancer [J]. Br J Surg, 2007, 94(12): 15551561.
13.	da Luz Moreira A, Mor I, Geisler DP, et al. Laparoscopic resection for rectal cancer: a casematched study [J]. Surg Endosc, 2011, 25(1): 278283.
14.	Tjandra JJ, Chan MK, Yeh CH. Laparoscopic vs. handassisted ultralow anterior resection: a prospective study [J]. Dis Colon Rectum, 2008, 51(1): 2631.
15.	Popescu I, Vasilescu C, Tomulescu V, et al. The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer. A single center experience [J]. Acta Chir Iugosl, 2010, 57(3): 2935.
16.	Lee KY， Kang J. Robotic colorectal surgery: Where are we right now? [J]. J Mech Eng Sci, 2010, 224(7): 14151419.
17.	Tuech JJ, Bridoux V, Kianifard B, et al. Natural orifice total mesorectal excision using transanal port and laparoscopic assistance [J]. Eur J Surg Oncol, 2011, 37(4): 334335.
18.	Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward [J]. Surg Endosc, 2010, 24(9): 22002205.
19.	Lindsetmo RO, Delaney CP. A standardized technique for laparoscopic rectal resection [J]. J Gastrointest Surg, 2009, 13(11): 20592063.
20.	王超，王權，曹雪源，等．腹壁無瘢痕腹腔鏡直腸癌根治術的3種標本取出途徑 [J]．世界華人消化雜志， 2010， 18（22）： 23842386．.
21.	Akamatsu H, Omori T, Oyama T, et al. Totally laparoscopic low anterior resection for lower rectal cancer: combination of a new technique for intracorporeal anastomosis with prolapsing technique [J]. Dig Surg, 2009, 26(6): 446450.
22.	Abraham NS, Byrne CM, Young JM, et al. Metaanalysis of nonrandomized comparative studies of the shortterm outcomes of laparoscopic resection for colorectal cancer [J]. ANZ J Surg, 2007, 77(7): 508516.
23.	Gao F, Cao YF, Chen LS. Metaanalysis of shortterm outcomes after laparoscopic resection for rectal cancer [J]. Int J Colorectal Dis, 2006, 21(7): 652656.
24.	Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a metaanalysis [J]. Ann Surg Oncol, 2006, 13(3): 413424.

1. Ong EJ, Stevenson AR. Current state of laparoscopic rectal cancer surgery in Australasia [J]. ANZ J Surg, 2011, 81(4): 281286.
2. Chand M, Heald RJ. Laparoscopic rectal cancer surgery [J]. Br J Surg, 2011, 98(2): 166167.
3. Laurent C, Leblanc F, Wütrich P, et al. Laparoscopic versus open surgery for rectal cancer: longterm oncologic results [J]. Ann Surg, 2009, 250(1): 5461.
4. Ng KH, Ng DC, Cheung HY, et al. Laparoscopic resection for rectal cancers: lessons learned from 579 cases [J]. Ann Surg, 2009, 249(1): 8286.
5. 王國俊，高春芳．腹腔鏡直腸癌全直腸系膜切除術 [J]．中國普外基礎與臨床雜志， 2011， 18（1）： 9294．.
6. Wexner SD, Bergamaschi R, Lacy A, et al. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference [J]. Surg Endosc, 2009, 23(2): 438443.
7. Nandakumar G, Fleshman JW. Laparoscopy for rectal cancer [J]. Surg Oncol Clin N Am, 2010, 19(4): 793802.
8. Bulut O, Nielsen CB. Singleincision laparoscopic low anterior resection for rectal cancer [J]. Int J Colorectal Dis, 2010, 25(10): 12611263.
9. Sylla P, Rattner DW, Delgado S, et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance [J]. Surg Endosc, 2010, 24(5): 12051210.
10. Lujan J, Valero G, Hernandez Q, et al. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer [J]. Br J Surg, 2009, 96(9): 982989.
11. Yano H, Ohnishi T, Kanoh T, et al. Handassisted laparoscopic low anterior resection for rectal carcinoma [J]. J Laparoendosc Adv Surg Tech A, 2005, 15(6): 611614.
12. Laurent C, Leblanc F, Gineste C, et al. Laparoscopic approach in surgical treatment of rectal cancer [J]. Br J Surg, 2007, 94(12): 15551561.
13. da Luz Moreira A, Mor I, Geisler DP, et al. Laparoscopic resection for rectal cancer: a casematched study [J]. Surg Endosc, 2011, 25(1): 278283.
14. Tjandra JJ, Chan MK, Yeh CH. Laparoscopic vs. handassisted ultralow anterior resection: a prospective study [J]. Dis Colon Rectum, 2008, 51(1): 2631.
15. Popescu I, Vasilescu C, Tomulescu V, et al. The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer. A single center experience [J]. Acta Chir Iugosl, 2010, 57(3): 2935.
16. Lee KY， Kang J. Robotic colorectal surgery: Where are we right now? [J]. J Mech Eng Sci, 2010, 224(7): 14151419.
17. Tuech JJ, Bridoux V, Kianifard B, et al. Natural orifice total mesorectal excision using transanal port and laparoscopic assistance [J]. Eur J Surg Oncol, 2011, 37(4): 334335.
18. Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward [J]. Surg Endosc, 2010, 24(9): 22002205.
19. Lindsetmo RO, Delaney CP. A standardized technique for laparoscopic rectal resection [J]. J Gastrointest Surg, 2009, 13(11): 20592063.
20. 王超，王權，曹雪源，等．腹壁無瘢痕腹腔鏡直腸癌根治術的3種標本取出途徑 [J]．世界華人消化雜志， 2010， 18（22）： 23842386．.
21. Akamatsu H, Omori T, Oyama T, et al. Totally laparoscopic low anterior resection for lower rectal cancer: combination of a new technique for intracorporeal anastomosis with prolapsing technique [J]. Dig Surg, 2009, 26(6): 446450.
22. Abraham NS, Byrne CM, Young JM, et al. Metaanalysis of nonrandomized comparative studies of the shortterm outcomes of laparoscopic resection for colorectal cancer [J]. ANZ J Surg, 2007, 77(7): 508516.
23. Gao F, Cao YF, Chen LS. Metaanalysis of shortterm outcomes after laparoscopic resection for rectal cancer [J]. Int J Colorectal Dis, 2006, 21(7): 652656.
24. Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a metaanalysis [J]. Ann Surg Oncol, 2006, 13(3): 413424.

《中國普外基礎與臨床雜志》

腹腔鏡直腸癌根治手術路徑的規范化及應用前景：附433例報道

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《中國普外基礎與臨床雜志》

腹腔鏡直腸癌根治手術路徑的規范化及應用前景： 附433例報道

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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腹腔鏡直腸癌根治手術路徑的規范化及應用前景：附433例報道

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