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改良抵钉座体外置入法在经肛门外翻切除标本腹部无辅助切口腹腔镜低位直肠癌根治术中的应用 被引量:1

Application of improved anvil placement in laparoscopic resection of low rectal cancer with resection of anal eversion
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摘要 目的探讨改良的抵钉座体外置入法在经肛门外翻切除标本的腹部无辅助切口腹腔镜低位直肠癌根治术中应用的可行性及临床价值。方法河南大学淮河医院普通外科于2015年6月至2017年6月期间,对17例低位直肠癌患者施行了改良的抵钉座体外置入法经肛门外翻切除标本的腹部无辅助切口腹腔镜低位直肠癌根治术。病例纳入标准:(1)肿瘤下缘距肛缘4-6cm的低位直肠癌;(2)隆起型肿瘤环周径〈3cm;(3)溃疡型肿瘤浸润肠管〈1/2周;(4)无远处转移,术前盆腔核磁共振提示T1-3N0M0;排除体质指数〉35kg/m^2者以及乙状结肠及其系膜长度不足或肥厚者。对这组患者的临床资料进行回顾性分析。术中患者均按照全直肠系膜切除(TME)原则,充分游离直肠及其系膜,肿瘤上缘预切断处裸化并离断肠管,经肛门置人卵圆钳夹取直肠残端经肛门将直肠外翻于体外,直视下在肿瘤下缘1~2cm处切断直肠,将乙状结肠远端经肛门拉出体外,置入抵钉座后荷包缝合,送回腹腔,荷包缝合直肠残端后行乙状结肠直肠端-端吻合。结果17例患者中,男性10例,女性7例,年龄42~71(中位数58)岁,体质指数20.6~33.5(中位数26.0)kg/m^2,术前肿瘤分期Ⅰ期2例,Ⅱ期15例;肿瘤距离肛缘4~6(中位数5.0)cm;肿瘤最大直径3.4~4.8(中位数4.2)cm。全组患者手术均顺利完成,无一例中转开腹,手术时间124~182(中位数136)min;1例患者因乙状结肠系膜游离不充分,致乙状结肠远端拉出体外困难,腹腔镜下再次充分游离乙状结肠降结肠后操作成功。术中出血量10—50(中位数20)ml。术后病理分期Ⅰ期2例,Ⅱ期12例,Ⅲ期3例:肿瘤分化程度:低分化腺癌1例,中分化腺癌15例,高分化腺癌1例。患者术后排气时间24~128(中位数36)h,住院时间5~15(中位数8)d。� Objective To investigate the feasibility and application value of improved anvil placement in laparoscopic resection of low rectal cancer with resection of anal eversion. Methods A retrospective study was performed on 17 patients who were operated by improved extracorporeal anvil placement in laparoscopic resection of low rectal cancer with resection of anal eversion at Huaihe Hospital of Henan University during June 2015 and June 2017. Inclusion criteria: (1) distance from tumor low margin to anal edge was 4 to 6 cm; (2) protrusive type tumor with a circumferential diameter of less than 3 cm; (3) ulcer type tumor with circumferential bowel infiltration of less than 1/2; (4) no distant metastasis(M0) and preoperative MRI of pelvic floor indicating T1-3N0. Patients with BMI〉 35 kg/m^2, or insufficient length of sigmoid and mesentery, or thickening sigmoid and mesentery were excluded. According to total mesorectal excision(TME) principle, rectum and its mesentery was resected completely; the sigmoid colon was cut off at the superior margin of tumor; the oval forceps was placed through anus to clamp and evert the rectum out of the anus; the rectum was transected at 1-2 cm from the lower edge of the tumor; the distal sigmoid colon was pulled out through anus ; purse string suture was made after insertion of anvil and was restored to the abdominal cavity; end-to-end anastomosis of the rectum and sigmoid colon was performed after closing rectal stump. Results Of 17 low rectal cancer patients, 10 were male and 7 were female with age of 42 to 71 (median 58) years old and BM! of 20.6 to 33.5 (median 26) kg/m2. Preoperative staging indicated 2 cases of stage I , 15 cases of stage II. Distance from tumor low margin to anal edge was 4 to 6 (median 5.0) cm and diameter of tumor was 3.4 to 4.8 (median 4.2) cm. All the patients completed operations successfully without conversion to laparotomy. The operation time was 124 to 182 (median 136) min. Distal sigmoid colon was difficult
作者 李兴旺 陈河金 李柄辉 王晨宇 张军杰 胡军红 Li Xingwang, Chen Herin, Li Binghui, Wang Chenyu, Zhang Junjie, Hu Junhong( Department of General Surgery, The Affiliated Huaihe Hospital, Henan University, Kaifeng 475000, China)
出处 《中华胃肠外科杂志》 CSCD 北大核心 2018年第8期913-917,共5页 Chinese Journal of Gastrointestinal Surgery
基金 吴阶平医学基金会临床科研专项资助基金(320.2710.1836) 河南省科技厅基础与前沿类重点项目(162300410101)
关键词 结直肠肿瘤 经自然腔道标本取出手术 腹腔镜 免辅助切口 抵钉座 Colorectal neoplasms Natural orifice specimen extraction surgery Laparoscopy None auxiliary incision Anvil
作者简介 李兴旺,男,1992年11月出生,医学硕士,住院医师,Email:kflxwang@163.com;;通信作者:胡军红。Email:hjh-8282@163.com胡军红,男,1976年8月出生,医学博士,主任医师,硕士生导师
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