Résumé
Objective To investigate the safety retention range of pelvic floor peritoneum by performing pathological examinations on pelvic floor peritoneal tissue at different distance from the rectolateral incisional margin during laparoscopic Miles surgery. Methods To conduct the research, pathological examination was performed on 50 patients who had undergone laparoscopic Miles surgery in Chengdu Fifth People′s Hospital from October 2015 to October 2017 and staged under cT3N0M0. The research examined their pelvic floor peritoneum at different distance from the rectum on the "yellow-white border line", with the incisal edge being the first pathological testing point, the area 5 mm from rectum being the second testing point, and the area 10 mm from rectum being the third testing point. Results Among these 50 cases, 4 of which had pathological staging pT2-3N1-2M0 and were excluded from the research. The other 46 cases had pathological staging pT2-3N0M0. After pathological examination of the three points of each case, no tumor cells were found. There was no difference in the positive rate of tumor cells at each site, and all of which was 0. The credibility interval of 95% was estimated (46 cases) and the check table value was 0 to 0.08. Conclusions The closure of the pelvic floor peritoneum is beneficial to the patient in laparoscopic Miles surgery. Moreover, for those low rectal cancer patients with T3N0M0, proper retention of pelvic floor peritoneum within 10 mm from the incisal edge is pathologically safe.
Résumé
Objective To investigate the comparative analysis between single-port access laparoscopic Miles surgery with jackknife position and laparoscopic Miles surgery with lithotomy position for low rectal cancer.Methods Retrospectively analyzed 36 patients with low rectal cancer (TNM stage:Ⅱ-Ⅲ) undergoing laparoscopic abdominoperineal excision.Patients were divided into two groups.Lithotomy position group:laparoscopic Miles surgery with lithotomy position.Jackknife position group:single-port access laparoscopic Miles surgery with jackknife position.The operation time,blood loss,postoperative recovery,postoperative complication,postoperative recurrence and survival rate were observed.Results Blood loss of perineal position in jackknife position group was less than that in lithotomy position group [(31.5 ± 22.4) ml vs.(53.5 ± 25.6) ml] (P =0.01),and removal of drainage tube in jackknife position group was earlier than that in lithotomy position group [(6.7 ± 1.9) d vs.(9.8 ± 1.7) d] (P ＜ 0.01).However,the operation time,blood loss in abdomen,blood loss,postoperative out-of-bed activity time,recovery of gastrointestinal function time,dermal sutures out time,postoperative hospital stay,complication,postoperative recurrence in 2 years and survival rate between two groups had no significant difference (P ＞0.05).Conclusions Single-port access laparoscopic Miles surgery is safe and feasible with better surgical outcome and cosmetic benefits.Furthermore,the blood loss and postoperative exudation at perineal region is less than that in traditional lithotomy position.