经自然腔道腔镜乙状结肠癌根治术一例

Natural orifice translumenal endoscopic surgery for radical resection of sigmoid colon cancer:a case report

目的评价经阴道自然腔道腔镜手术(NOTES)行乙状结肠癌根治术的安全性和可行性。方法患者已婚女性,63岁,明确诊断为乙状结肠癌。术前评估无绝对手术禁忌,在全麻下实施经阴道NOTES乙状结肠癌根治术。分析手术操作、手术时间、术中出血、术后恢复、切除标本等情况。结果手术时间155 min,术中出血量50 ml。患者术后第1天下床活动,第2天进流质饮食,第3天胃肠道功能恢复,第4天拔除腹腔引流管和尿管,采用术后芬太尼静脉患者自控镇痛泵镇痛,术后3 d停药,未诉疼痛,术后住院时间为6 d。未出现任何并发症。病理报告:结肠中分化腺癌,肿瘤侵及肠壁全层,上、下切缘阴性,淋巴结未见转移(0/14)。结论经阴道NOTES手术行乙状结肠癌根治术是安全和可行的。

Objective Natural orifice translumenal endoscopic surgery（ NOTES） is a newly developed surgical technique. We present a case of sigmoid colon radical resection by using transvaginal NOTES. The aim of this study was to evaluate the safety and feasibility of transvaginal NOTES for sigmoid colon radical resection. Methods A female patient with sigmoid colon cancer（ 63-year-old and married）without surgical contraindication in preoperative evaluation underwent a transvaginal NOTES radical sigmoidectomy by general anaesthesia. Clinical data were collected and analyzed, including operative procedures,operation time,blood loss,postoperative recovery,and surgical specimen. Results Operation time was 155 minutes. Blood loss was 50 ml. The patient began out-of-bed activities on postoperative day 1,oral fluid intake on day 2 and bowel movement on day 3. The drainage tube and urinary catheter were removed on postoperative day 4. Intravenous infusion pump of patient-controlled analgesia with fentanyl was administrated for 3 days, without complaint of postoperative pain. The patient was discharged on the postoperative day 6. There were no complications. Pathological results showed median differentiated colon adenocarcinoma. The tumor invaded full thickness of the colon wall. The proximal and distal margins were negative. There was no metastasis in lymph nodes（ 0 /14）. Conclusion Transvaginal NOTES radical sigmoidectomy for sigmoid colon cancer is feasible and can be performed safely.