经自然腔道取标本手术之精准功能保肛术操作要点

Surgical key points of precision functional sphincter-preserving surgery

保肛手术的原则是在直肠癌根治性切除基础上尽量保存肛门括约肌功能。由于肿瘤位置低,传统腹腔镜手术在骨盆深部操作困难,易造成组织游离不确切,肿瘤下缘定位不准,组织牵拉过度,远端直肠切除过多等缺点,且腹壁辅助切口疼痛影响术后康复。精准功能保肛术(PPS)借助刘氏经肛微创切除系统,在经腹手术中尽量保留左结肠动脉及盆腔自主神经,经肛手术中依靠透明螺纹扩肛器在开放直视的清晰视野下进行肿瘤下缘的测量、定位与切除。肠管离断后,标本经肛取出,避免腹壁切口。肠道支撑器撑托结肠残端,并与肛管行手工垂直褥式缝合全层肠管后放置特制肛管,无需常规预防性造瘘。PPS术同时解决了精准切除和功能保肛两大难题。

The principle of sphincter-preserving surgery is to preserve the anal sphincter function under the premise of radical resection.Due to low position of rectal tumor,conventional laparoscopic surgery has difficulties in operating in the deep and narrow pelvis,which may lead to inaccurate tissue dissociation,imprecise positioning of tumor edge,excessive stretch of the anal sphincter complex,and excessive removal of distal rectal mucosa.Moreover,pain from abdominal auxiliary incision has an unavoidable side effect for postoperative recovery.With the help of the Liu's transanal microsurgery system,precision functional sphincter-preserving surgery(PPS)can be successfully performed.PPS tries to preserve left colonic artery and pelvic autonomic nerve in the transabdominal operation.In the part of transanal surgery,measurement,localization and resection of the lower edge of the tumor are conducted under a clear and open visual field with the transparent screw anal dilator.After the rectum is cut off,the specimen is taken out through the anus to avoid abdominal incision.Inserting the intestinal supporter to support the bowel stump,full thickness of bowel stump is then sutured with anal canal by vertical mattress suture.Special transanal tube is placed afterwards without routine prophylactic stoma.PPS can achieve precise tumor resection and sphincter preservation simultaneously.