经自然腔道取标本在腹腔镜直肠癌根治术中的应用进展

Clinical application of laparoscopic natural orifice specimen extraction surgery for rectal cancer

直肠癌根治手术从最初提出全直肠系膜切除(TME)理念到腹腔镜广泛应用于直肠癌根治,经过30多年的迅猛发展,腹腔镜直肠癌TME手术现已成为直肠癌患者的首选术式,但是该手术用于取出肿瘤标本的腹壁辅助切口与当今微创手术理念相悖,避免腹壁切口成为胃肠外科医生和直肠癌患者共同诉求。经自然腔道取标本手术(NOSES)在全腔镜下完成直肠癌根治及消化道的重建,标本经自然腔道(直肠或者阴道)取出,无腹壁辅助切口,更符合微创实际,操作更简便。研究NOSES腹腔镜直肠癌根治术的手术进展,旨在为该术式提供一定的参考。

Radical surgery for rectal cancer has evolved from the initial concept of total mesorctal excision(TME)to the wide application of laparoscopic surgery.After rapid development in the past 30 years,laparoscopic TME surgery for rectal cancer has become the first choice for those patients with rectal cancer.However,the auxiliary abdominal incision which is used to remove resected specimens is contrary to the current concept of minimally invasive surgery.Avoiding abdominal wall incisions has become a common appeal of gastrointestinal surgeons and patients with rectal cancer.Natural orififice specimen extraction surgery(NOSES)could solve the problem of abdominal wall auxiliary incision,which could ensure both radical resection of rectal cancer and the gastrointestinal reconstruction by laparoscopic operation completely.The specimens could be taken out either from rectum or vagina without an auxiliary incision,which is more in line with minimally invasive practice and easier to operate.To investigate the current progress of laparoscopic NOSES for rectal cancer could provide reference for our colleague.