经脐单孔加一孔机器人直肠癌全直肠系膜切除术初探

Preliminary application and efficacy analysis of transumbilical single-incision plus one port robotic total mesorectal excision

目的探讨经脐单孔加一孔机器人直肠癌全系膜切除术的可行性。方法回顾性分析陆军军医大学大坪医院普通外科于2019年9月18日成功实施的1例经脐单孔加一孔机器人直肠上段癌全直肠系膜切除术的70岁男性患者临床资料。体质指数22.1 kg/m2,术前检查示:直肠上段肿瘤距离肛缘14 cm,大小为2.5 cm×1.5 cm×1.0 cm,中分化腺癌;周围脂肪间隙模糊,提示肿瘤浸润。结果手术顺利,无中转,腹部无辅助切口,标本系膜完整。手术时间165 min,术中出血量约20 ml,术中无周围脏器损伤等并发症发生。术后病理示直肠上段溃疡型中分化腺癌,TNM分期ⅣA期(T4N2b);术后恢复顺利,第1天下床活动,第7天拔除尿管,第8天出院。结论经脐单孔加一孔机器人直肠癌全直肠系膜切除术安全有效、可行。

Objective To investigate the feasibility of transumbilical single-incision plus one port(SIPOP)robotic total mesorectal excision.Methods Clinical data of a 70-year-old male patient with BMI 22.1 kg/m2 who successfully underwent transumbilical single-incision plus 1 port robotic total mesorectal resection of upper rectal cancer at the General Surgery Department of Daping Hospital of Army Military Medical University on September 18,2019 were retrospectively analyzed.Preoperative colonoscopy revealed that the distance of upper rectal cancer to anal edge was 14 cm,and the tumor size was 2.5 cm×1.5 cm×1 cm.Pathological result confirmed rectal moderately differentiated adenocarcinoma.The preoperative abdominal CT showed thickened bowel-wall of upper rectum and the blurred perirectal fat,suggesting tumor infiltration.Results The operation was successful.There were no conversion to laparotomy or abdominal auxiliary incision,and the mesorectum of the specimen was intact.The operation time was 165 minutes,the blood loss was about 20 ml,and there were no complications such as injury to peripheral organs.Postoperative pathology showed ulcerative moderately differentiated adenocarcinoma of the upper rectum with TNM stage IVA(T4N2b).The postoperative recovery was smooth.Patient ambulated on the 1st day,the catheter was removed on the 7th day,and discharged from the hospital on the 8th day.Conclusion The transumbilical SIPOP robotic total mesorectal excision is safe,effective and feasible.