全腹腔镜下低位直肠癌根治术:新荷包技术联合经肛门外翻切除标本

Totally laparoscopic anterior resection for lower rectal cancer: combination of a new purse-string technique with prolapsing technique

目的:探讨全腹腔镜低位直肠癌根治术中采用新荷包技术联合经肛门外翻切除标本的安全性及临床价值。方法:2013年2月至2017年12月为16例患者应用新荷包技术联合经肛门外翻切除标本技术行全腹腔镜低位直肠癌根治术,全直肠系膜切除术后于近上切缘上端乙状结肠处做半环形切开,将带有缝针的吻合器钉座置入乙状结肠内,缝针穿出结肠壁引导钉座中心杆穿透结肠壁,靠近钉座处上直线切割闭合器,离断乙状结肠,并将钉座固定于近端乙状结肠内。经肛门置入卵圆钳,远端直肠外翻拉出体外,行直肠远端、乙状结肠吻合。结果:16例手术均顺利完成,无一例中转开腹,手术时间平均(158.0±32.0)min,术中出血量平均(80.0±18.0)ml,术后肛门排气时间平均(2.1±0.3)d,术后平均住院(9.2±1.6)d,未发生吻合口漏、狭窄。术后随访3~56个月,未发现肿瘤局部复发及远处转移。结论:全腹腔镜低位直肠癌根治术中采用新荷包技术联合经肛门外翻切除标本是安全、可行的。

Objective： Laparoscopically assisted low rectal anterior resection is difficult even for experienced surgeons because of difficulties in selecting the appropriate transection line and completing anastomosis in the narrow pelvic space. The prolapsing technique resolves these problems.In this study,combination of this new purse-string technique for intracorporeal anastomosis with prolapsing technique was applied in totally laparoscopic low anterior resection,its safety and clinical value was investigated.Methods： Between Feb.2013 and Dec.2017,16 patients,who underwent totally laparoscopic low anterior resection with combination of a new purse-string technique with prolapsing technique,were included in this study.After the total mesorectal excision,a semi-circumferential colotomy was made at the anterior colonic wall just proximal to the proximal transection site. The anvil of a circular stapling device,secured with a Prolene suture,was introduced via the colotomy.The suture was advanced anteriorly so that the center rod of the anvil penetrated the colonic wall.The colon was staple-transected at this point to secure the anvil on the proximal colon. The distal rectum was everted and transanally pulled out of the body using a grasping forceps inserted from the anus.Staple-closure and transection of the distal rectum was performed under direct vision.Anastomosis was established using a circular stapler.Results： Totally laparoscopic low anterior resections using this technique were performed for 16 patients with rectal cancer. There was no conversion to laparotomy,anastomotic leakage or stenosis.The operative time was（ 158.0±32.0） min,intraoperative blood loss was（ 80.0±18.0） ml,postoperative anal exhaust time was（ 2.1±0.3） d,postoperative hospital stay was（ 9.2±1.6） d.There were no local recurrence or distant metastasis in any patients during follow-up.Conclusions： Combination of a new purse-string technique with prolapsing technique is safe and feasible in totally laparoscopic low anterior resection for rectal cancer.