新荷包技术联合经肛门外翻切除在全腹腔镜下低位直肠癌根治术中的应用

Application of new purse-string technique plus resection via rectal eversion in totally laparoscopic radical resection for low rectal cancer

目的:讨论应用新荷包技术在全腹腔镜下低位直肠癌根治术中的可行性及近期疗效。方法:分析6例应用新荷包技术行全腹腔镜下低位直肠癌根治术患者资料。患者在全腹腔镜下完成全直肠系膜切除术后,将带有缝针的钉座通过靠近上切缘处乙状结肠肠壁切口置入乙状结肠肠腔内,然后将缝针从肠壁穿出,引导钉座杆穿出肠壁,靠近钉座处用直线切闭器切断结肠;远端肠壁连同肿瘤经肛门外翻拉出体外,在直视下行肿瘤下切缘的切割闭合,完成吻合。结果:6例患者手术均顺利完成,无中转开腹;手术时间为(165±21)min,出血(55±12)m L;无吻合口瘘;术后随访未发现肿瘤局部复发及远处转移。结论:新荷包技术应用于全腔镜下直肠癌根治术具有较高的安全性及良好的短期效果,远期疗效有待进一步观察。

Objective：To investigate the feasibility and short-term efficacy of new purse-string technique in totally laparoscopic radical resection for lower rectal cancer.Methods：The data of 6 patients with low rectal cancer undergoing totally laparoscopic radical resection with new purse-string technique were analyzed.In these patients,after totally laparoscopic total mesorectal excision,the anvil of the circular-stapling device secured with a suture needle was inserted into the lumen of the sigmoid colon through an incision on the sigmoid colon wall close to the proximal transection margin,and then the accompanying needle was advanced through colonic wall and pulled out so that the center rod of the anvil penetrated the colonic wall,following which the colon was transected by a linear cutter stapler near the site to secure the anvil.Next,the distal tumor-bearing rectosigmoid colon was everted and pulled transanally outside the body,staple-closure and transection of the distal rectum was done under direct vision,and then anastomosis was performed.Results：The operative procedures were successfully completed in all the 6 patients,and there was no conversion to laparotomy.The operative time was（165±21） min and intraoperative blood loss was（55±12） mL.No anastomotic leakage occurred,and no local recurrence or distant metastasis was found in any of the patients during follow-up.Conclusion：Using new purse-string technique in totally laparoscopic lower rectal cancer resection has high safety and significant short-term results,but the long-term results require further evaluation.