NOSES左结直肠癌根治术取标本困难病例的回顾性分析

A retrospective analysis of surgical difficulties in natural orifice specimen extraction surgery

目的评价经自然腔道取出标本的全腹腔镜下结直肠癌根治术使用蔡氏套管器的临床应用价值。方法通过自制的专利器械——蔡氏套管器,对70例结直肠癌患者,行经自然腔道取出标本的全腹腔镜下结直肠癌根治术,并对患者的临床及手术资料进行回顾性分析。结果 70例患者均在全腹腔镜下完成手术,标本均经过肛门取出。其中降结肠癌7例,乙状结肠癌35例,直乙交界处癌2例,直肠中上段癌26例。无中转开腹和围手术期死亡。通过分析,术前使用"体质肿瘤指数"进行患者的评分,评估手术标本取出难易程度,同时,术中使用抵钉座置入等全腹腔镜下手术技术,顺利完成手术。结论经肛门自然腔道取出标本的全腹腔镜下结直肠癌根治术操作安全、创伤小、疼痛轻、更美观,可达到根治性切除的效果。并且可对更高位置的结肠肿瘤如降结肠癌实施全腹腔镜下手术切除,经肛取出标本,在肿瘤根治的基础上进一步提高了微创性。

ObjectiveTo evaluate the clinical application value of laparoscopic-assisted natural ori？ce specimen extraction radical colectomy by Cai tube. MethodsColorectal cancer surgery for samples obtained from natural orifice under full laparoscopy was conducted on seventy colorectal cancer patients by self-developed surgical instruments-Cai tube. Patients′ clinical data were retrospectively analyzed. ResultsSurgeries of seventy patients were completed under full laparoscopy. Samples were obtained through anus. Wherein, seven cases, thirty-？ve cases, two cases and twenty-six cases belonged to cancer of descending colon, sigmoid, sigmoid-rectum junction, and rectum, respectively. Perioperative mortality was not discovered. Through retrospective analysis, we use the ″Body Mass Tumor Index″ to score patients before surgery to assess the ease of removal of surgical specimens. ConclusionsColorectal cancer surgery for samples obtained from natural ori？ce under full laparoscopy is characterized by safe operation, small trauma, lighter pain and more beautiful appearance, and radical resection effect can be achieved. In addition, higher colon cancer, such as cancer of descending colon, can be surgically excised under full laparoscopic colon surgery, and samples can be obtained from anus. Minimally invasive feature can be further improved on the basis of radical resection.