中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (07): 806-811.DOI: 10.19538/j.cjps.issn1005-2208.2025.07.15

• 论著 • 上一篇    下一篇

全腹腔镜超低位保肛手术中采用外翻视野下切除部分齿状线和肛管全层安全性及有效性研究

胡    刚，邢兆东，杜锦波，邱文龙，李    博，王语涵，汤坚强   

  1. 国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院结直肠外科，北京100021
  • 出版日期:2025-07-01 发布日期:2025-07-27

  • Online:2025-07-01 Published:2025-07-27

摘要： 目的    探讨全腹腔镜超低位保肛手术中采用外翻视野下切除部分齿状线和肛管全层方法的安全性及有效性。方法    回顾性分析2021年4月至 2023 年7月中国医学科学院肿瘤医院结直肠外科同一手术团队收治的行全腹腔镜超低位保肛手术的16例低位直肠癌（距齿状线≤1 cm）病人的临床资料，术中均采用外翻视野下切除部分齿状线和肛管全层的方法。收集手术相关指标和围手术期并发症等资料，采用低位前切除综合征（LARS）评分、Wexner评分等对肛门功能进行评估。结果    16例病人均顺利完成手术，无中转开放手术病例。肿瘤距肛缘距离为3.0（2.0～3.5）cm，手术时间为（179.5±94.9）min，术中出血33（10~100）mL，吻合口距肛缘距离为2.5（1.0~3.0）cm。手术标本切缘均为阴性。术后2例病人发生并发症，其中1例为术后9 d发生出血，急诊行介入止血；另1例发生肛周脓肿，保守治疗好转。造口还纳距初次手术时间为7.5（3~13）个月。随访22（14~41）个月，无局部复发，还纳后2年LARS评分为（13.5±4.2）分，Wexner评分为（4.2±1.9）分，肛门功能良好。结论    外翻视野下切除部分齿状线和肛管全层的全腹腔镜超低位保肛手术可应用于肿瘤距齿状线≤1 cm低位直肠癌的极限保肛治疗，显示出较好的肿瘤学结局和肛门功能，但其长期疗效及相对于传统术式的优势仍有待进一步研究。 

关键词: 直肠外翻, 经括约肌间切除术, 低位直肠癌, 极限保肛, 肛门功能

Abstract: To evaluate the safety and anal efficacy of total laparoscopic ultra-low sphincter preservation using partial resection of partial dentate line and full-thickness anal canal after rectal eversion. Methods    A retrospective analysis was conducted on clinical data from patients with low rectal cancer (≤1 cm from the dentate line) who underwent the described procedure by the same surgical team at the Colorectal Surgery Department of the Cancer Hospital, Chinese Academy of Medical Sciences, between April 2021 and July 2023. Partial resection of the dentate line and the entire layer of the anal canal under the eversion field of view was adopted. Data including Intraoperative data and perioperative complications was collected, and anal function (LARS and Wexner scores) were recorded to evaluate anal function. Results    16 patients included in the study received operation successfully, with no conversions to open surgery. The median tumor distance from the anal verge was 3.0 (2.0-3.5) cm. The mean operative time was (179.5±94.9) min, with a median blood loss of 33 (10-100) mL. The anastomosis was 2.5 (1.0-3.0) cm from the anal verge, and all surgical margins were negative. Two perioperative complications occurred: one case of postoperative hematochezia on day 9 requiring emergency interventional hemostasis, and one case of perianal abscess managed conservatively. The median time to stoma reversal was 7.5 (3-13) months. With a median follow-up of 24 months, no local recurrence was observed. The mean LARS score at 2 years after stoma reversal was 13.5±4.2, and the mean Wexner score was 4.2±1.9, indicating good anal function. Conclusion    Total laparoscopic ultra-low anterior resection with partial dentate line and full-thickness anal canal resection under everted vision is a feasible option for sphincter preservation in patients with extremely low rectal cancer, demonstrating favorable oncological outcomes and anal function. However, further studies are needed to evaluate its long-term efficacy and advantages over traditional techniques.

Key words: rectal eversion, intersphincteric resection, low rectal cancer, ultra-low sphincter preservation, anal function