TEM缝合技术关闭盆底腹膜在腹腔镜直肠癌腹会阴联合切除术中的应用

Pelvic Peritonization by Using TEM Suture Technique after Laparoscopic Abdominoperineal Resection for Rectal Carcinoma

目的探讨经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)缝合技术关闭盆底腹膜在腹腔镜直肠癌腹会阴联合切除术(abdominoperineal resection,APR)中应用的可行性和有效性。方法回顾性分析2010年9月～2012年7月间在我院接受择期腹腔镜APR手术的低位直肠癌患者32例。术中在完成淋巴结清扫及肿瘤切除后,借鉴TEM独特的腔内缝合技术,使用TEM持针钳,用可吸收线连续缝合关闭盆底腹膜,两端分别用Hemo-lock夹锁定。分析盆底腹膜缝合的成功率、会阴切口感染与肠梗阻的发生率。结果本组32例患者中29例术中成功关闭盆底腹膜,成功率为90.6%。缝合关闭盆底腹膜所用的时间平均为15(10～30)min。盆底腹膜缝合成功的29例患者,会阴切口感染和肠梗阻的发生率均为3.4%(1/29);而盆底腹膜缝合失败的3例患者,会阴切口感染和肠梗阻的发生率则均为33.3%(1/3)。结论腹腔镜直肠癌APR手术中关闭盆底腹膜是必要的,采用TEM腔内缝合技术关闭盆底腹膜是可行的、有效的。

Objective To investigate the feasibility and efficacy of closing pelvic peritoneum by using transanal endoscopic microsurgery （TEM） suture technique after laparoscopic abdominoperineal resection for rectal carcinoma. Methods Thirty-two patients undergoing selective laparoscopic abdominoperineal resection for low-rectal carcinoma in our hospital from September 2010 to July 2012 were analyzed retrospectively. By learning from the unique TEM intracorporeal suture technique, the pelvic peritoneum was closed by continuous suture after lymph node dissection and tumor excision during operation, using TEM needle-forceps and an ab- sorbable suture with Hemo-lock clip grasping two sides. The achievement ratio of closing pelvic peritoneum and the occurrence rate of perineal incision infection and intestinal obstruction were analyzed respectively. Results The pelvic peritoneum was closed successfully in 29 patients of all the 32 patients, with an achievement ratio of 90.6%. The average time for closing the pelvic peritoneum by suturing wasl5 minutes （range of 10 to 30 mi- nutes）. The occurrence rate of perineal incision infection and intestinal obstruction in the 29 patients whose pelvic peritoneum closed successfully were both 3.4% （ 1/29）, while that was both 33.3% （1/3） in the 3 pa- tients whose pelvic peritoneum failed to be closed. Conclusions Closing pelvic peritoneum is necessary after laparoseopic abdominoperineal resection for rectal carcinoma. It is feasible and effective to close pelvic peritone- um by using TEM intraeorporeal suture technique.