探讨套袖式吻合技术在腹腔镜超低位直肠癌保肛手术的安全性、有效性及近期疗效。

回顾性分析中国医学科学院北京协和医学院肿瘤医院2018年4月至2019年2月采用套袖式吻合技术完成的腹腔镜超低位直肠癌保肛手术患者的临床资料，统计并分析患者的临床特征、病理特征、手术和术后恢复情况、围手术期并发症及术后肛门功能等资料。

共有40例患者成功完成应用套袖式吻合技术的腹腔镜超低位直肠癌保肛手术，2例患者术中因结肠残端血供较差行预防性回肠造口，其中21例（52.5%）患者术前行新辅助治疗，肿瘤距肛缘中位距离为4 cm，中位手术时间为166.5 min，中位术中出血量为20.0 mL。肿瘤中位长径为2.5 cm，中位近端切缘长度为10.3 cm，中位远端切缘长度为1.0 cm，中位淋巴结检出数目为13.10枚。患者术后中位下地时间、进食时间、排气时间和住院时间分别为19.0 h、12.5 h、20.5 h和6.0 d，中位住院费用为47 646.0元。随访过程中，结肠残端回缩入盆腔的中位时间为12.0 d，其中4例（10%）患者术后出现吻合口漏，行临时性肠造口手术后逐渐好转，1例（2.5%）患者术后出现结肠残端出血，4例（10%）患者术后出现肛周粪水性皮炎，2例（5%）患者术后出现肛周疼痛，均予对症止处理后好转。术后3个月采用低前切除综合征（LARS）评分量表评估肛门功能，其中，8例（20%）无LARS，23例（57.5%）轻度LARS，9例（22.5%）重度LARS。随访期间无患者肿瘤复发或者转移。

应用套袖式吻合技术的腹腔镜超低位直肠癌保肛手术安全可行，避免了常规预防性造口，近期疗效较为满意，其远期疗效待进一步随访观察。

This study aims to explore the clinical safety and feasibility of oversleeve anastomosis in laparoscopic sphincter-preserving surgery for ultra-low rectal cancer.

From April, 2018 to February, 2019, we conducted laparoscopic sphincter-preserving surgery using the oversleeve anastomosis technique in patients with ultra-low rectal cancer in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Data regarding clinical characteristics, pathological characteristics, surgical and postoperative outcomes, perioperative complications and anal functions were collected and analyzed.

We successfully performed laparoscopic sphincter-preserving surgery with the oversleeve anastomosis technique in 40 patients, including 2 patients receiving prophylactic stoma due to bad blood supply of the colonic stump. Among the patients, 21(52.5%) patients received neoadjuvant therapy. The median distance of the tumor from the anal verge was 4.0 cm. The median operation time was 166.5 minutes and intraoperative blood loss was 20.0 mL. The median length of tumor was 2.5 cm. The median proximal and distal resection margin was 10.63 cm and 1.0 cm. The median time to ground activity, time to fluid diet intake, time to flatus, and length of hospital stay were 19.0 hours, 12.5 hours, 20.5 hours and 6.0 days, respectively. The mean hospitalization cost was 47 646.0 RMB. During the follow-up period, the median time of colonic stump retracted back to the rectal cavity was postoperative day 12.0. Four patients (10%) experienced anastomosis leakage, one patient (2.5%) experienced colonic stump bleeding, four patients (10%) experienced perianal fecal dermatitis and two patients (5%) experienced anal pain. All of them recovered after symptomatic treatment. The low anterior resection syndrome (LARS) score was used to evaluate the anal function on 3 months after surgery. 8 patients (20%) had no LARS, 23 patients (57.5%) had minor LARS, and 9 patients (22.5%) had major LARS. No tumor recurrence or metastasis were observed in any patient.

This study indicates that oversleeve anastomosis shows promise as a safe and feasible procedure with satisfactory short-term outcomes in laparoscopic sphincter-saving surgery without the routine use of prophylactic stoma for ultra-low rectal cancer. But the long-term outcomes need to be explored.