完全经肛全直肠系膜切除术联合括约肌间切除治疗超低位直肠癌

发布时间：2018-08-10 18:26

【摘要】：目的探索应用完全经肛全直肠系膜切除(pure transanal total mesorectal excision,pure-TaTME)联合括约肌间切除(intersphincteric resection,ISR)治疗超低位直肠癌术式的安全性及可行性。方法经过术前肠镜、直肠腔内超声及盆腔磁共振(magnetic resonance imaging,MRI)等检查进行评估,筛选出本例超低位直肠癌患者,顺利施行pure-TaTME联合ISR手术:利用肛门牵开器充分显露肛管,直视下完成ISR手术。然后建立经肛手术路径,完全经肛完成pure-TaTME手术,并创建肠道的连续性。结果手术时间350 min,术中出血量200 mL。切除标本长约18 cm,远断端切缘1.0 cm,直肠系膜完整。术后病理报告为直肠高级别锯齿状腺瘤,局灶黏膜内癌变,远近断端及环周切缘阴性;检出淋巴结32枚,未见癌转移。病理分期为p T1N0M0。患者术后恢复满意,术后3d肠道功能恢复,开始进流食,术后第5天进半流食,无感染及吻合口瘘发生。至今随访24个月,大便控制功能良好,未见肿瘤复发转移。结论完全经肛全直肠系膜切除(pure-TaTME)联合括约肌间切除(ISR)治疗超低位直肠癌安全可行,这为低位甚至超低位直肠癌的外科治疗提供了一种可行性选择,但远期效果还需要更多病例进行临床研究来确定。
[Abstract]:Objective To explore the safety and feasibility of total transanal mesorectal excision (pure-TaTME) combined with intersphincteric resection (ISR) for ultra-low rectal cancer. Pure-TaTME combined with ISR was successfully performed in this patient with ultra-low rectal cancer. ISR was performed under direct vision after full exposure of the anal canal with an anal retractor. A transanal approach was established to complete the pure-TaTME operation through the anus, and the intestinal continuity was created. The resected specimens were about 18 cm in length and 1.0 cm in the distal cut edge with intact mesorectal membrane.The pathological report was high grade serrated adenoma of rectum, local intramucosal carcinogenesis, negative distal and proximal cut edge and circumferential cut edge.32 lymph nodes were detected and no metastasis was found.The pathological stage was p T1N0M0. No infection or anastomotic leakage occurred. Up to now, 24 months follow-up showed that the stool control function was good and no recurrence or metastasis was found. Surgical treatment of bowel cancer provides a viable option, but long-term outcomes require more clinical studies to determine.
【作者单位】：首都医科大学附属北京友谊医院普通外科肿瘤侵袭和转移机制研究北京市重点实验室国家消化系统疾病临床医学研究中心;北京大学第三医院普通外科;
【基金】：国家科技支撑计划课题(2015BAI13B09) 北京市医院管理局临床医学发展专项(ZYLX201504) 首都医科大学附属北京友谊医院科研启动基金(YYQDKT2016-5) 北京大学第三医院临床重点项目基金(BYSY2016018)~~
【分类号】：R735.37

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