目的

探讨腹腔镜下免保护性造口经肛拖出式一期结肠肛管吻合术（LOPC）在低位直肠癌保肛治疗中的应用价值。

方法

采用描述性研究方法，回顾性分析2020 年2 月至2023 年3 月河南省人民医院收治的21 例T1～T2 期低位直肠癌行LOPC 治疗患者的临床病理资料，其中，男性11 例，女性10 例，中位年龄56（40～69）岁，观察患者术中及术后手术相关指标、并发症、肛门功能和肿瘤复发情况。随访截止到2023 年9 月1 日。

结果

21 例患者均顺利完成LOPC，均保留肛门，无中转开腹或手术方式变更。全组中位手术时间200（115～280）分钟，中位出血量100（50～300）mL，均未行预防性造口，所有患者均可进行R0 切除，中位清扫淋巴结数量为17（12～26）个，术后中位平均住院时间为10（7～13）天，无术后吻合口漏，无围手术期死亡者。患者均获得术后随访，中位随访12（6～41）个月，术后6 个月中位LARS 评分26（19～40）分，随访期间无肿瘤复发转移。

结论

腹腔镜下免保护性造口经肛拖出式一期结肠肛管吻合术治疗低位直肠癌是安全可行的。

Objective

To investigate the application value of laparoscopic transanal one-stage pull-through coloanal anastomosis with no protective stoma （LOPC） in the anal preservation treatment of low rectal cancer.

Methods

A retrospective descriptive research was conducted.Retrospective analysis of the clinical and pathological data of 21 patients with T1～T2 stage low rectal cancer treated with LOPC at He'nan Provincial People's Hospital from February 2020 to March 2023.There were 11 males and 10 females，with a median age of 56 （40～69） years.The patient's intraoperative and postoperative surgical indicators，complications， anal function， and tumor recurrence were all recorded.The deadline for follow-up is September 1，2023.

Results

All 21 patients successfully completed LOPC and retained their anus， without any conversion to open surgery or changes in surgical methods.The median surgical time was 200 （115～280） minutes， with a median bleeding volume of 100 （50～200） milliliters.No protective stoma was performed， and all patients were eligible for R0 resection.An average of 17 （12～26） lymph nodes were cleared， and the average hospital stay was 10 （7～13） days.There were no postoperative anastomotic leakage or perioperative deaths.All patients received postoperative follow-up， with a median follow-up of 12 （6～41） months and a LARS score of 26 （19～40） points at 6 months postoperatively.There was no tumor recurrence or metastasis during the follow-up period.

Conclusion

LOPC is safe and effective for the treatment of low rectal cancer.