目的: 研究单孔加一孔腹腔镜手术在直肠癌根治术中的可行性、安全性、肿瘤根治程度、近期疗效以及操作优势。方法: 回顾性分析2013年9月至2018年1月间,在我科接受单孔加一孔腹腔镜直肠癌根治术20例病人的临床资料。另从采用单孔腹腔镜手术的直肠癌病人（n=62）中按1∶1的比例进行倾向性评分匹配,选出20例作为对照组。倾向性评分匹配因素包括年龄、性别、体质量指数（body mass index, BMI）、美国麻醉协会分级（≤2/>2）和 TNM（0~Ⅰ/Ⅱ/Ⅲ）分期。分析两组的临床资料以及手术结果。结果: 两组在手术时间、术中出血量、肿瘤大小、淋巴结清扫数、切口长度以及术后住院时间上,均无统计学差异。肿瘤距肛缘的距离上在两组间有统计学差异（P<0.05）。单孔加一孔组的中位随访时间为24.5个月,对照组为26.5个月。两组均无肿瘤复发。结论: 单孔加一孔腹腔镜直肠癌根治术可行和安全,可用于治疗距肛缘更近的直肠癌。
Objective To assess feasibility and safety of single-incision plus one laparoscopic surgery (SILS+1) in radical treatment of rectal cancer combined with analysis of short-term clinical and oncological outcomes. Methods Clinical data were studied retrospectively with 20 patients who underwent radical rectal cancer resection through SILS+1 from September 2013 to January 2018 in our department. A propensity score matching approach was used on pooled the data of 62 cases with single-incision laparoscopic surgery of rectal cancer at a radio of 1∶1 as control group of 20 cases after matching the demographic information of the patients and body mass index, American Society of Anesthesiologists score (≤2/>2) and TNM (0-Ⅰ/Ⅱ/Ⅲ) stage. Clinical data and operative results were analyzed between SILS+1 group and control group. Results No significant differences were observed in operative time, blood loss, tumor size, retrieved lymph node, length of incision, postoperative hospital stay between SILS+1 group and control group. However, SILS+1 group showed significantly shorter distance of rectal cancer from the anal verge (P<0.05). The median follow-up period was 24.5 months in SILS+1 group and 26.5 months in control group. There was no recurrent case in both groups. Conclusions SILS+1 for rectal cancer is feasible and safe, and can be used to treat rectal cancer more near from the anal verge.
[1] Bucher P, Pugin F, Morel P.Single port access laparoscopic right hemicolectomy[J]. Colorectal Dis,2008,23(10):1013-1016.
[2] Remzi FH, Kirat HT, Kaouk JH, et al.Single-port laparoscopy in colorectal surgery[J]. Colorectal Dis,2008,10(8):823-826.
[3] Bucher P, Pugin F, Morel P.Transumbilical single incision laparoscopic sigmoidectomy for benign disease[J]. Colorectal Dis,2010,12(1):61-65.
[4] Hirano Y, Hattori M, Douden K, et al. Single-incision laparoscopic surgery for colorectal cancer[J]. World J Gastrointest Surg,2016,27:8(1):95-100.
[5] Hirano Y, Hattori M, Douden K, et al.Single-incision plus one port laparoscopic anterior resection for rectal cancer as a reduced port surgery[J]. Scand J Surg,2012, 101(4):283-286.
[6] 李佑, 蒋奕玫, 刘坤, 等. 经脐单孔腹腔镜技术在治疗乙状结肠癌中应用的探索性经验[J]. 外科理论与实践,2016,21(6):483-487.
[7] Ragupathi M, Ramos-Valadez DI, Yaakovian MD, et al.Single-incision laparoscopic colectomy: a novel approach through a Pfannenstiel incision[J]. Tech Coloproctol,2011, 15(1):61-65.
[8] Mettler L, Nikam YA.A comparative survey of various uterine manipulators used in operative laparoscopy[J]. Gynecol Surg,2006,3(4):239-243.
[9] Bulut O, Nielsen CB.Single-incision laparoscopic low anterior resection for rectal cancer[J]. Int J Colorectal Dis,2010,25(10):1261-1263.
[10] Uematsu D, Akiyama G, Magishi A, et al.Single-access laparoscopic left and right hemicolectomy combined with extracorporeal magnetic retraction[J]. Dis Colon Rectum,2010,53(6):944-948.
[11] Huscher CG, Mingoli A, Sgarzini G, et al.Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study[J]. Am J Surg,2012,204(1):115-120.
[12] Poon JT, Cheung CW, Fan JK, et al.Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized controlled trial[J]. Surg Endosc,2012,26(10):2729-2734.
[13] Watanabe J, Ota M, Fujii S, et al.Randomized clinical trial of single-incision versus multiport laparoscopic colectomy[J]. Br J Surg,2016,103(10):1276-1281.
[14] Kang BM, Park SJ, Lee KY, et al.Single-port laparoscopic surgery can be performed safely and appropriately for colon cancer: short-term results of a pilot randomized controlled trial[J]. J Laparoendosc Adv Surg Tech A,2017,27(5):501-509.
[15] Kim JS, Cho SY, Min BS, et al.Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique[J]. Am Coll Surg,2009,209(6):694-701.
