- 期刊
Laparoscopic Abdominoperineal Resection for Lower Rectal Malignancy in National Taiwan University Hospital: Eight-Year Experience
腹腔鏡腹部會陰聯合切除手術於低為直腸癌：臺大醫院之八年經驗
摘要
目的：腹腔鏡腹部會陰聯合切除手術已經用於低位直腸癌的治療。本篇研究旨在探討臺大醫院於腹腔鏡腹部會陰聯合切除手術的手術結果。方法：自2003年1月至2011年11月，總共有37位接受腹腔鏡腹部會陰聯合切除手術的低位直腸癌患者並收案進行分析。低位直腸癌之定義為距肛門口6公分之直腸惡性腫瘤。腹腔鏡手術遵循下述癌症廓清原則：完整腫瘤清除、下腸繫膜血管之高位結紮、不接觸腫瘤以及全直腸繫膜切除。結果：腹腔鏡腹部會陰聯合切除手術成功地實行於所有患者而毋須轉換為開腹手術。共有16位男性以及21位女性患者，平均年齡是61.5 ± 13.6歲（範圍從30歲至85歲）。病理分期如下：第一期9位患者，第二期12位，第三期13位以及第四期3位。平均手術時間為298.3 ± 77.3分鐘。除了一位患者因為會陰部膿瘍產生而必須再次接受清創手術，所有患者皆順利出院。無術中的併發症發生。依據Clavien-Dindo併發症分類，其中2名患者屬於第一級，6名屬第二級，而1名屬第三級。所有患者皆定期回診追蹤，其中一名患者發生局部復發，12名患者發生遠端轉移。估算三年存活率為82.17%。結論：對於低位直腸癌而言，腹腔鏡腹部會陰聯合切除手術是安全而且可行的手術。依癌症廓清原則而施行腹腔鏡腹部會陰聯合切除手術可確保滿意的治療成果。
並列摘要
Purpose. Laparoscopic abdominoperineal resection (APR) has been used in the management of lower rectal cancer. The purpose of this study was to assess our experience in laparoscopic APR at National Taiwan University Hospital.Methods. Between January 2003 and November 2011, 37 patients who were diagnosed as lower rectal malignancy and who underwent laparoscopic APR were enrolled in this study. Lower rectal malignancy was defined as the cancer located within 6cm above the anal verge. Laparoscopic resection was based on the following oncological principles: en bloc resection with high ligation of inferior mesenteric vessels, no-touch isolation and total mesorectal excision.Results. Laparoscopic APR was successfully performed in all patients without conversion. There were 16 male and 21 female patients with an average age of 61.5±13.6 years (range: 30-85 years). The pathological TNM staging was distributed as following: stage I in 9 patients, stage II in 12 patients, stage III in 13 patients, and stage IV in 3 patients. The mean operation time was 298.3±77.3 minutes. All the patients experienced a quick recovery except one patient had perineal abscess formation requiring surgical debridement. There was no intraoperative complication. By the Clavien-Dindo complication classification, there were grade I complication in 2 patients, grade II in 6 patients, and grade III in 1 patient. One patient developed local recurrence, and 12 patients developed distant metastases. The estimated 3-year survival rate was 82.17%.Conclusions. Laparoscopic APR was a safe and feasible procedure for lower rectal malignancy. Following the surgical principle of laparoscopic APR ensured satisfactory oncological outcomes.