肛管恶性肿瘤合并巨腹征围手术期处理及机器人辅助手术治疗

Perioperative management and operative treatment of malignant tumor of anal canal merging severe abdominal protuberance

目的报告本中心1例肛管恶性肿瘤合并巨腹征经围手术期处理及机器人辅助微创手术结果。方法患者男性,66岁,肛管腺癌(T3N0M0)合并巨结肠、巨膀胱、脊柱侧弯。因结肠和膀胱极度扩张导致巨腹征,左侧膈肌明显上移心脏被推移至胸腔右侧,肛管狭窄合并不全肠梗阻表现。术前准备:术前1周无渣饮食,静脉营养,反复多次灌肠,排出大肠内积存粪便和气体。术前3 d置导尿管,生理盐水冲洗膀胱;巨腹征得到明显缓解后,在机器人辅助下行腹会阴联合直肠癌根治术+结肠次全切除术+结肠造口术。结果患者术后6 h饮水,24 h下床活动,48 h内排气,术后第3天半流质饮食,第6天顺利出院。结论肛管恶性肿瘤合并巨腹征患者,经过精准有效的术前准备,巨腹征缓解后,在机器人辅助下施行微创手术是安全可行的。

Objective To report the perioperative management and robot-assisted minimally invasive surgery results of one case with malignant tumor of anal canal combined with severe abdominal distention.Methods A 66-year-old male suffer from adenocarcinoma of anal canal(T3N0M0)with megacolon,megabladder and scoliosis.The extreme distention of the colon and bladder result in severe abdominal distention.The left diaphragm moved up markedly and the heart was moved to the right side of the thoracic cavity.Moreover,there was also anal stenosis with incomplete intestinal obstruction.Preoperative preparation:fluid diet,intravenous nutrition and repeated enema to void feces and gas in the large intestine 1 week before operation.Foley catheter was placed three days before surgery and irrigated with saline.After relief of abdominal distention,robotic-assisted abdominoperineal resection+subtotal colectomy+colostomy was performed.Results Water intake within 6 hours post-operatively;ambulance on Day 1;anal passage of gas on Day 2;semi-fluid diet on Day 3;safely discharged on Day 6.Conclusion Robotic-assisted minimally invasive surgery is safe and feasible for patients with malignant tumor of anal canal combined with severe abdominal distention after appropriate and effective preoperative preparation to relieve abdominal distention.