腹部无切口经肛门切除标本的腹腔镜低位直肠癌根治套入式吻合手术配合

Perioperative cooperation of laparoscopic annus-preserving resection for low rectal cancer by TCMA without abdominal incision

目的探讨腹腔镜低位直肠癌根治腹部无切口经肛门切除标本套入式吻合保肛术手术配合方法及配合模式。方法对30例低位直肠癌经腹腔镜下根治腹部无切口经肛门切除标本行套入式吻合保肛术的手术配合,均采用统一的整体规范管理模式,四做到:术前访视患者、术前与手术医师沟通、术前熟悉解剖与手术程序、术前特殊仪器和器械准备。六配合:手术体位配合、气腹建立配合、上夹切断肠系膜下动静脉配合、游离直肠下段配合、肛门显露与切除标本配合、套入式吻合配合。结果本组30例低位直肠癌患者,平均手术时间为178 min,腹部手术时间约为132 min,经肛门套入式吻合操作时间46 min,术中无任何意外发生,无中转手术,均顺利完成手术。结论腹部无切口经肛门切除标本的腹腔镜低位直肠癌根治套入式吻合是一个创新手术,手术配合强调规范化,四做到、六配合模式是有效配合手术医师顺利完成手术的重要保证。

Objective To investigate the methods and patterns of perioperoative cooperation of laparoscopic annus-preserving resection for low rectal cancer by TCMA without abdominal incision.Methods Thirty patients with low rectal cancer who had undergone laparoscopic annus-preserving resection by TCMA without abdominal incision received standardized pattern of perioperoative cooperation and management.The pattern of perioperative cooperation and management included four tips：preoperative interview of patients,preoperative communication with surgeons,preoperative review of anatomy and surgical procedures and preoperative preparation of specified instruments and equipments.And six cooperations included surgical position,establishment of aeroperitoneum,clamping and resection of inferior mesenteric vessels,desection of the low part of the rectum,exposure of the annus,and removal of specimens and TCMA operation.Results All of the 30 patients underwent surgery successfully with no complications and intraoperative conversion.The average operation time was 178 minutes,including 132 minutes for abdominal procedures and 46 minutes for TCMA procedures.Conclusions It is an innovative surgical procedure of laparoscopic annus-preserving resection for low rectal cancer by TCMA without abdominal incision.Four tips and sixcooperations are very important for the smooth surgical procedures.