机器人结直肠切除术经自然腔道取标本(NOSES)手工吻合消化道重建

Robotic colorectal resection with hand-sewn anastomosis of the digestive tract and nature orifice specimen extraction

目的:探讨机器人结直肠切除术经自然腔道取标本(natural orifice specimen extraction surgery,NOSES)手工吻合消化道重建的可行性和安全性。方法:回顾性分析2020年5月至2022年7月浙江省人民医院胃肠胰外科收治的机器人结直肠切除术患者临床资料。手术方式为机器人直肠癌或乙状结肠癌根治术,经肛门取标本,腔内手工吻合消化道重建。结果:共10例患者完成机器人结直肠NOSES术手工吻合消化道重建,男性4例,女性6例,年龄范围33~82岁。手术时间100~190 min,中位数120 min;术中出血量10~100 ml,中位数40 ml,无输血;术后住院时间8~18 d,中位数10 d;无中转开放手术,无二次手术,无围术期死亡。围术期并发症(Clavien-Dindo分级):Ⅲ级1例、Ⅱ级2例、Ⅰ级1例;发生1例吻合口漏,保守治疗成功。结论:随着腔内吻合技术的提高,尤其是机器人手术的应用,机器人结直肠切除术经自然腔道取标本(NOSES)手工吻合消化道重建安全可行。

Objective:To investigate the feasibility and safety of robotic colorectal resection with hand-sewn anastomosis of the digestive tract and nature orifice specimen extraction.Methods:The clinical date of 10 patients diagnosed with colorectal tumor who were treated with robotic colorectal resection with hand-sewn anastomosis of the digestive tract and nature orifice specimen extraction from May 2020 to July 2022 at the Division of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People’s Hospital were retrospectively studied.Results:There were 4 males and 6 females,with the age range from 33 to 82 years,received robotic colorectal resection with hand-sewn anastomosis of the digestive tract and nature orifice specimen extraction.The surgical specimen is removed through the rectum.The median operative time was 120(ranged 100 to 190)minutes.The intraoperative blood loss was 40(ranged 10 to 100)ml and there was no intraoperative blood transfusion.The median postoperative hospital stay was 10(ranged 8 to 18)days.There were no transit open surgery,re-operation and mortality.Perioperative complications(Clavien-Dindo grade):1 case of gradeⅢ,2 cases of gradeⅡ,1 case of gradeⅠ;1 case developed anastomotic leakage,successful through conservative treatment.Conclusion:Robotic colorectal resection with hand-sewn anastomosis of the digestive tract and nature orifice specimen extraction was effective and safe to treat colorectal tumor with the improvement of intra-abdominal anastomosis technology.