Objective To explore the efficacy of modified total laparoscopic mesorectal excision for rectal cancer. Methods From August 2008 to September 2010, we performed a modified total laparoscopic mesorectal excision on 16 patients with rectal cancer. To complete the procedure, a catheter was used to place a stapler into the colon close to the lesion via the anus; afterwards, we made a hole on the wall of the colon to pull out the arm of the stapler, and then under a laparoscope, we cut the colon 3 cm away from the stapler. The tumor and adjacent colon were pulled out via the anus, and the stump was then put back for the anastomosis between the colon and rectum, or colon and anus. No abdominal assisted incision was used. Results The procedure was completed successfully in all the cases without conversion to open surgery. The operation time ranged from 170 to 290 min with a mean of 230 min, and intraoperative blood loss ranged from 50 to 100 ml with a mean of 55 ml. No residual cancer tissues were detected at the resection margin. The patient recovered their gastrointestinal function in 40 to 60 hours with a mean of 52 hours, and postoperative hospital stay was 4 to 7 days (mean, 5 days). No anastomotic leakage or hemorrhage occurred. We followed up the patients for 14 to 36 months(mean,26 months) , during which no abnormal defecation (1-2 times/day) , no sexual function disorder or dysuria; B-ultrasonography and CT showed no local recurrence or distant metastasis, no tumor implantation at the sites of anastomosis or trocar; no adhesive intestinal obstruction was reported. Conclusion Total laparoscopic mesorectal excision is effective for rectal cancer, and is worth being used widely.%目的 探讨改良无腹壁辅助切口直肠经肛门拖出法完全腹腔镜全直肠系膜切除术治疗直肠癌的临床应用价值. 方法 2008年8月～2010年9月对16例直肠癌行改良完全腹腔镜全直肠系膜切除术,利用引导管将吻合器钉座自肛门置入肿瘤近侧结肠,结肠壁上戳孔引出吻合器钉座拉杆,腔镜下直线切割闭合器离断距离吻合器钉座远端3 cm的结肠.远侧带瘤肠管内翻经肛门拖出、切除,残端荷包缝合后还纳,吻合器从肛门进入,腹腔内腹腔镜直视下用吻合器行结直肠或结肠肛管吻合,无须腹部辅助切口. 结果 16例手术全部成功,无中转开腹手术.手术时间170～290 min,平均230 min.术中出血50～ 100 ml,平均55 ml.切缘均无癌残留.术后40 ～ 60 h,平均52 h胃肠功能恢复.术后住院时间4～7d,平均5d.16例随访14～36个月,平均26个月:排便习惯均正常,1～2次/d;无明显性功能障碍和排尿困难；14例B超及CT检查无局部复发及远处转移发生,吻合口、trocar口无肿瘤种植,无粘连性肠梗阻发生. 结论 改良完全腹腔镜全直肠系膜切除术临床效果较好,值得临床推广应用.
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