腹部无切口腹腔镜直肠癌经肛门切除吻合术

Laparoscopic trans-anus resection of rectal cancer without abdominal incision

采用中间路入,用超声刀裸化肠系膜下动静脉并清扫淋巴结,于肠系膜下动静脉根部施夹并切断;游离乙状结肠与左侧腹壁的生理粘连处;按TME原则向下游离直肠达肿瘤远端3-5 cm。肛门采用挂钩牵开器,显露齿状线上2.0 cm,用超声刀环行切开黏膜下向上潜行剥离直肠黏膜长2-4 cm切断直肠,将直肠肿瘤及乙状结肠从肛门拖出体外,距肿瘤约10 cm近心端切断乙状结肠,距齿状线上2 cm处将套入远端结肠浆肌层与直肠肌鞘缝合4针固定,近端结肠全层与齿状线上直肠黏膜及肠黏膜层行间断缝合,取下挂钩肛门牵开器,将吻合口还纳肛门内复位。

A middle approach was employed with an ultrasonic knife to dissect the inferior mesenteric vein and artery and to cut off vessels at their roots respectively,while cleansing lymph nodes. According to TME,the physiological adhesion of the sigmoid and the left lateral region of the abdomen were mobilized. The rectum was dissected to ensure a distal tumor margin of 3-5 cm. The operative field above the dentate line was exposed by using an anal hook retractor. A circumferential incision of the mucosa was made at 2 cm above the dentate line. After mobilizing the rectum through the mucosal plane to 2-4 cm,the distal end of the colon was pulled through the anus and was cut off 10 cm above the superior tumor margin. TCMA of the sero-muscular layer and muscular sheath was performed at 2 cm above the dentate line,while four sutures for fixation and relaxation as well as anastomosis of the distal end of the colon and the residual rectal mucosa. Finally,the anal hook retractor was removed and the anastomotic stoma was repositioned back into the anal canal.