经肛全直肠系膜切除术用于直肠癌吻合口复发的再手术

doi:10.16139/j.1007-9610.2023.02.09

摘要/Abstract

摘要：

目的：探讨经肛全直肠系膜切除术（transanal total mesorectal excision, TaTME）在直肠癌吻合口复发再手术中的可行性及安全性。 方法：回顾性收集2020年4月至2021年12月瑞金医院收治的5例直肠癌术后吻合口复发行腹腔镜辅助TaTME病人的临床资料。分析病人围术期情况、病理检查结果和近期随访。结果：5例均顺利完成腹腔镜辅助TaTME手术。手术时间（206.00±19.49）min，无术中并发症发生，1例术中遭遇错误间隙。术后发生吻合口漏1例，吻合口狭窄1例。所有病人的切除标本均完整，无环周切缘阳性和远切缘阳性。中位随访(15.20±2.39)个月。1例病人出现排便功能障碍，无肿瘤复发、转移及肿瘤相关性死亡。结论：腹腔镜辅助TaTME对直肠癌术后吻合口复发再手术病人，提供了一种新型、安全有效的手术入路和切除方式，近期随访满意。

关键词: 经肛全直肠系膜切除术, 直肠癌, 吻合口复发, 经肛微创手术

Abstract:

Objective To investigate the feasibility and safety of transanal total mesorectal excision (TaTME) in re-operation for anastomosis recurrence rectal cancer. Methods Five patients with anastomosis recurrence rectal cancer underwent TaTME at Ruijin Hospital between April 2020 and December 2021 were retrospectively enrolled in this study. The peri-operative situation, pathological examination, and short-term follow-up results were analyzed. Results All cases were operated laparoscopic TaTME successfully. The operative time was (206.00±19.49) min without intraoperative complications. One case encountered incorrect dissection plane. Anastomotic leakage occurred in one case and anastomotic stenosis developed in another case. The specimens quality of mesorectum deemed complete in all cases without both positive circumferential resection margin and positive distal resection margin. There was (15.20±2.39) months of median follow-up and one case found defecation disorder. Tumor recurrence, metastasis and tumor-related death were not found. Conclusions For patients with anastomosis recurrence rectal cancer, laparoscopic TaTME procedure is novel type and would be safe and effective surgical approach with satisfactory short-term follow-up.

Key words: Transanal total mesorectal excision, Rectal cancer, Anastomosis recurrence, Transanal minimal invasive surgery

中图分类号:

R735.37

潘林锋, 徐玺谟, 巴突尔·艾克木, 邓漾, 张森, 秦伟, 殳舵获, 蔡正昊, 宋海勤, 杨晓, 钟昊, 胡延岩, 李健文, 冯波. 经肛全直肠系膜切除术用于直肠癌吻合口复发的再手术[J]. 外科理论与实践, 2023, 28(02): 132-138.

PAN Linfeng, XU Ximo, Batuer Aikemu, DENG Yang, ZHANG Sen, QIN Wei, SHU Duohuo, CAI Zhenghao, SONG Haiqin, YANG Xiao, ZHONG Hao, HU Yanyan, LI Jianwen, FENG Bo. Transanal total mesorectal excision in re-operation for anastomosis recurrence rectal cancer[J]. Journal of Surgery Concepts & Practice, 2023, 28(02): 132-138.

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Item	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5
Age (years old)	71	55	63	68	49
Gender	Male	Male	Female	Female	Male
BMI（kg/m²）	23.6	24.3	25.8	26.2	22.9
Distance from anal verge（cm）	6.0	6.5	5.5	5.0	7.0
Tumor diameter（cm）	2.0	2.5	3.0	2.5	2.0
Diabetes	Yes	No	No	No	No
Primary surgery date	2017/10	2018/01	2018/03	2018/07	2018/11
Primary tumor stage	pT₃N₀M₀	pT₃N₁M₀	pT₃N₁M₀	pT₃N₀M₀	pT₃N₁M₀
Primary surgery approach	Open TME	L-TME	L-TME	L-TME	L-TME
Chemotherapy regime	XELOX	XELOX	XELOX	XELOX	XELOX