FAP伴直肠腺瘤癌变患者行腹腔镜大肠次全切除复合NOSES手术

Laparoscopic subtotal colectomy with complex NOESE surgery for FAP with rectal adenoma canceration patient

目的探讨腹腔镜大肠次全切除术中组合应用两种不同取标本方式行经自然腔道取标本手术(natural orifice specimen extraction surgery, NOSES)的可行性。方法2019年2月,四川省肿瘤医院收治了1例家族腺瘤性息肉病(familial adenomatous polyposis, FAP)合并直肠息肉癌变的患者,腹腔镜大肠次全切除术中先使用切除拖出的方式经直肠取出结肠标本,然后以经肛外翻拖出的方式切除直肠标本,顺利完成NOSES。结果手术时间约360 min,术中出血量50 ml,术后12 d顺利出院,无手术相关并发症发生。结论腹腔镜大肠次全切除复合NOSES安全可行,对有适应证的FAP患者有较好的临床应用前景,可以更好地展现NOSES技术的微创优势。

Objective Laparoscopic subtotal colectomy NOSES surgery utilizing two different methods to extract the specimen combinatorially hasn′t been reported. We report one case of laparoscopic subtotal colectomy with complex NOESE surgery for a patient with familial adenomatous polyposis (FAP). Methods A FAP patient with rectal adenoma canceration was administrated in Gastrointestinal Surgery Center, Sichuan Cancer Hospital in Feb. 2019. Laparoscopic subtotal colectomy NOSES surgery was performed successfully, with colon specimen resection and extraction via rectum and rectal specimen resection via transanal eversion technique successively. The postoperative outcome was evaluated. Results Operation time was 360 min and blood loss was 50 ml. In-hospital stay was 12 days and no surgical complications were noticed. Conclusions Laparoscopic subtotal colectomy with complex NOESE surgery is safe and feasible for patients with indications, which can better demonstrate the minimally invasive advantages of NOSES technology and may have a good prospect of clinical application.