腹腔镜下结肠吻合技术在结直肠癌经自然腔道取标本手术中的应用

The application of intracorporeal colonic anastomosis in natural orifice specimen extraction surgery

微创手术成为目前结直肠癌外科治疗的热点,经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)作为微创手术的一枝新秀,已在我国获得广泛应用。相比于直肠,结肠体内吻合更为复杂和困难。随着外科技术的不断进步,NOSES中结肠体内吻合技术不断成熟并多样化。NOSES中结肠体内吻合目前最主要的分类方法是按照吻合方向与两侧肠管蠕动方向的关系分为逆蠕动吻合和顺蠕动吻合,其中最具代表性的为"三角吻合"和"重叠三角吻合"。本文对NOSES中结肠体内吻合技术的发展与演变,代表性术式的主要手术步骤,以及目前的相关争论进行了详细的阐述,并综合既往研究,对NOSES中结肠体内吻合的技术要点进行了总结和概述,最后对结肠癌NOSES中较为理想的结肠体内吻合技术进行了展望。

Minimally invasive surgery has become the focus of modern surgical therapy for colorectal cancer,and as one rising star of it,NOSES has been widely applied and developed in China. Compared with rectal cancer,intracorporeal colonic anastomosis is more complex and difficult. With the continuous development of surgical technology,intracorporeal colonic anastomosis in NOSES becomes mature and diversified. Peristaltic anastomosis and antiperistaltic anastomosis are two main ways classified according to the relationship of anastomosis direction and intestinal peristaltic direction,among which delta-shaped anastomosis and overlapped delta-shaped anastomosis are the most representative surgical technique respectively. In this artical,we offer a detailed overview of evolution of intracorporeal colonic anastomosis in NOSES,main surgical processes of representative technique and currently relative arguments. After summarization of the key points in intracorporeal colonic anastomosis on the basis of previous researches,we are also looking forward to better intracorporeal colonic anastomosis in NOSES in the future.