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目的探讨腹腔镜下经肛手套通路手术治疗直肠肿瘤的可行性及疗效。方法回顾性搜集我院2015年3月至2016年3月期间经评估适合行局部切除的直肠肿瘤患者17例,使用腹腔镜下经肛手套通路治疗。以手套联合切口保护套建立腹腔镜操作通路,使用腹腔镜作为照明设备,将超声刀、操作钳及镜头分别从3个指套伸入固定在手套上的鞘卡里。结果 17例患者的手术均获得成功,手术时间为35~90 min,平均54 min。制作密闭手套通路时间11~26 min,平均18 min。肿瘤直径1.4~3.5 cm,平均2.4 cm。术后病理结果:绒毛状腺瘤8例,高级别上皮内瘤变3例,低级别上皮内瘤变1例,类癌3例,腺癌2例。所有肿瘤组织标本切缘阴性。无感染、肠瘘、大出血等并发症。住院时间为4~9 d,平均5 d。门诊随访1–6个月,无一例失访,无远期并发症及复发。结论从本组有限的数据资料来看,腹腔镜下经肛手套通路手术治疗直肠肿瘤具有操作简单、安全有效的特点,为直肠肿瘤的个体化综合治疗提供了一种新选择。
Objective To investigate the feasibility and efficacy of laparoscopic surgery for rectal cancer via anal glove access. Methods Retrospectively collected 17 cases of rectal cancer patients who were evaluated for partial resection in our hospital from March 2015 to March 2016, and treated with laparoscopic transanal approach. To establish a laparoscopic access with a glove joint incision protector, using a laparoscope as a lighting device, an ultrasonic scalpel, an operating forceps and a lens were respectively extended from three finger covers into a sheath card fixed on the glove. Results All the 17 cases were operated successfully. The operation time ranged from 35 to 90 minutes with an average of 54 minutes. Making airtight gloves access time 11 ~ 26 min, an average of 18 min. Tumor diameter 1.4 ~ 3.5 cm, an average of 2.4 cm. Pathological results: 8 cases of villous adenoma, 3 cases of high grade intraepithelial neoplasia, 1 case of low grade intraepithelial neoplasia, 3 carcinoid tumors and 2 adenocarcinoma. All tumor tissue specimens negative margin. No infection, intestinal fistula, bleeding and other complications. The length of hospital stay was 4 to 9 days with an average of 5 days. Outpatient follow-up 1-6 months, no case of loss of follow-up, no long-term complications and recurrence. Conclusions From this group of limited data, laparoscopic surgery via rectal glove pathology of rectal cancer with simple, safe and effective features, provides a new choice for the comprehensive treatment of rectal cancer.