手助腹腔镜直肠癌根治术的优势与评价

Virtues and evaluation of hand-assisted laparoscopic resection for rectal cancer

手辅助腹腔镜手术作为腹腔镜手术的重要组成部分,近年来在直肠癌根治手术中的应用越来越多。虽然其手术步骤与全腹腔镜手术大概一致,但由于腹腔内有灵敏触觉的手存在,因此兼顾了微创腹腔镜和开放手术的优势。手辅助腹腔镜直肠癌手术具有学习曲线短、中转开腹率低、手术时间短、适应证广等优点,并且可以快速有效控制出血等术中意外的发生,提高了手术的安全性。手虽然给腹腔镜直肠癌手术带来许多便利,但同时也会占据腹腔内的有限空间,造成腹腔内气腹严密性减低,术者的辅助手易疲劳等缺点。

Hand-assisted laparoscopic surgery （HALS）, which allows a surgeon to put hands into the abdominal cavity through a special hand port while maintaining the pneumoperitoneum, has been proposed as an useful alternative in treating rectal cancers. Combined application of hand-assisted operation and conventional techniques of laparoscopic surgery has facilitated the operative procedures with preservation of tactile sensation, which is usually lacking in conventional laparoscopic procedures. It also has improved the eye-to-hand coordination, while allowing hands to be used for blunt dissection and permitting a rapid control of unexpected intraoperative bleeding. The above factors could contribute to a significant reduction of operative time, with a short learning curve, a lower rate of conversion to open surgery and wide indications. Moreover, HALS provides hybrid procedures with advantages of minimally invasive and conventional open surgery. Nevertheless, the defects of HALS in rectal surgery include fatigue of hands, occupancy in a narrow pelvic cavity, and descending of abdominal gas-tightness.