目的 探讨3D腹腔镜下超低位直肠癌根治术中结肠肛管吻合术(3D腹腔镜改良Parks手术)保肛的治疗效果.方法 回顾性分析2014年3月至2015年12月期间36例采用3D腹腔镜改良Parks手术患者的临床资料.评估其术后并发症以及肛门控粪、排尿和性功能状况.结果 全组患者随访6~24个月.术后出现吻合口瘘2例,吻合口狭窄3例,发生肝转移1例,无局部复发病例.术后6个月、1年和2年对排粪情况满意者分别占63.9%(23/36)、85.7%(24/28)和85.0%(17/20).术后1个月排尿功能障碍发生率为13.9%(5/36);男性患者术后1个月勃起功能障碍发生率为28.5%(6/21),射精功能障碍发生率为33.3%(7/21).女性患者术后1个月对性生活满意者占66.6%(10/15).结论 3D腹腔镜在改良Parks手术中可以提高超低位直肠癌患者的保肛率,且术后控便功能、排尿及性功能满意.%Objective To evaluate the efficacy of transanal coloanal anastomosis under 3D medical laparoscop-ic system (modified Parks procedure) in sphincter-preserving surgery for ultra-low rectal carcinoma. Methods The clin-ical data of 36 ultra-low rectal cancer patients undergoing laparoscopic modified Parks procedure from March 2014 to December 2015 in our center were reviewed retrospectively. Postoperative complications, fecal continence, urination and sexual function were evaluated. Results All the patients were followed up from 6 to 24 months after operation. Anasto-motic leakage was found in 2 cases, anastomotic stricture in 3 cases, and hepatic metastasis in 1 case. No local recur-rence occurred. The ratio of satisfactory defecation function was 63.9%(23/36) in six months, 85.7%(24/28) in 1 year and 85.0%(17/20) in 2 years respectively. Urinary dysfunction was found in 5 patients (13.9%, 5/36) in 1 month after op-eration. Among 21 male patients, 6 (28.5%) presented erectile dysfunction and 7 (33.3%) presented ejaculation dysfunc-tion. Among 15 female patients, sexual life was satisfactory in 10 (66.6%) patients. Conclusion Laparoscopic modified Parks procedure in sphincter-preserving surgery for ultra-low rectal cancer can increase the probability of anus reserva-tion, and improve the functional outcomes of defecation, urination and sex.
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