196例腹腔镜直肠癌根治术精准切除及保留盆腔神经的治疗体会

摘要

Objective:To summarize the experience of laparoscopic rectal cancer resection.Methods:The clinical data of 196 patients was reviewed retrospectively after laparoscopic rectal cancer radical resection.Results:All 196 patients after laparoscopic rectal cancer radical resection left hospital in 7 ~35 days.Abdominal bleeding occurred in 3 cases,and 2 cases were improved after conservative treatment.5 cases of anastomotic fistula were improved after conservative treatment.Liver metastasis and anastomotic metastasis occurred in 4 cases after 1 year,16 cases(8%) with early(during 14 days)II level voiding dysfunction,7 cases(4%)with III level voiding dysfunction,11 cases (6%)with II level voiding dysfunction after three months,8 cases(4%)with III level postoperative voiding dysfunc-tion.In 102 male patients,76 cases were followed -up,with erectile dysfunction in 9 cases(12%)for Ⅱ level and 5 cases(6%)for Ⅲ level.All patients were followed -up for 3 ~5 years,and satisfaction rate was 92%,of which 163 cases were performed postoperative chemotherapy treatment,14 cases with postoperative radiotherapy.23 cases died in 2 years.3 -year survival rate was 78%.5 -year survival rate was 52%.In I period cases,the 3 -year survival rate was 98% and 5 -years survival rate was 97%.In II period cases,the 3 -year survival rate was 83%.5 -years sur-vival rate was 79%.In III period cases,the 3 -year survival rate was 52% and 5 -year survival rate was 49%.In VI period cases,the 3 -year survival rate was 39% and 5 -year survival rate was 30%.Conclusion:Laparoscopic resec-tion of rectal cancer can accurately excise mesorectum and protect pelvic nerve,reduce tumor recurrence and metasta-sis,reduce urination and sexual disorders and other complications.%目的：总结腹腔镜直肠癌根治术的应用体会。方法：回顾性分析196例腹腔镜直肠癌根治术患者的临床资料。结果：196例患者术后均于7～35天内出院，发生腹腔内出血3例，2例经保守治疗好转，1例经再次手术止血；5例出现吻合口瘘，均给予保守治疗后好转。4例1年后出现肝脏转移和吻合口转移，16例（8％）出现早期（14天内）II 级排尿功能障碍，7例（4％）出现 III 级排尿功能障碍，11例（6％）出现术后3个月II 级排尿功能障碍，8例（4％）出现术后 III 级排尿功能障碍。102例男性患者，随访患者性生活情况，76例获得随访，出现9例 II 级（12％）和 5例 III 级（6％）勃起功能障碍。所有患者均获3～5年随访，满意率为92％。其中163例术后行化疗，14例行术后放疗，23例术后1～2年内死亡。总的3年存活率为78％，5年存活率为52％。I 期患者3年存活率为98％，5年为97％；II 期患者3年存活率为83％，5年为79％；III 期患者3年存活率为52％，5年为49％；VI 期患者3年存活率为39％，5年为30％，大致与国内大样本统计相同。结论：腹腔镜直肠癌根治术是安全可行的，术中能够精准切除直肠系膜及保护盆腔神经。