引用本文:赵晓芳,付川川,郑阳春,易 波,王五艺,陈 超,赵 滨,许培培,张 轲,芮元祎.腹腔镜下低位直肠癌经肛外翻拖出切除的自然腔道取标本手术操作技巧探讨[J].中国临床新医学,2022,15(9):836-839.
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腹腔镜下低位直肠癌经肛外翻拖出切除的自然腔道取标本手术操作技巧探讨
赵晓芳,付川川,郑阳春,易 波,王五艺,陈 超,赵 滨,许培培,张 轲,芮元祎
610041 成都,四川省肿瘤医院手术室(赵晓芳),胃肠外科中心(付川川,郑阳春,易 波,王五艺,陈 超,赵 滨,许培培,张 轲,芮元祎)
摘要:
[摘要] 目的 探讨腹腔镜下低位直肠癌经肛外翻拖出切除的自然腔道取标本手术(NOSES)操作技巧。方法 选择2017年1月至2021年12月于四川省肿瘤医院行腹腔镜下经肛外翻拖出切除的NOSES的低位直肠癌患者67例,分析其手术时间、术中出血、术后并发症、住院时间及肿瘤复发、转移等情况。结果 本组67例患者均顺利完成手术,无一例中转开腹。其中,3例患者同时行单侧侧方淋巴结清扫,43例(64.2%)术中行预防性回肠造瘘。手术时间为200~590 min,平均为320.1 min;术中出血量为5~300 ml,平均为64.3 ml。无一例发生腹腔污染。术后平均21.9 h(1~88 h)经肛门或造瘘口排气。术后发生吻合口漏1例,尿潴留3例,不全性肠梗阻5例,均行保守治疗后痊愈。术后平均住院时间为10.6 d(7~26 d)。术后随访至2022年6月,发现盆腔复发1例,出现远处转移5例。结论 腹腔镜下经肛外翻拖出切除的NOSES具有创伤小、恢复快、疗效好等优点。只要术前严格把控适应证,恪守无菌和无瘤原则,掌握关键操作技巧,可以有效地避免腹腔污染,降低肿瘤医源性扩散风险。
关键词:  腹腔镜  低位直肠癌  经自然腔道取标本手术  操作技巧
DOI:10.3969/j.issn.1674-3806.2022.09.12
分类号:R 735.3+5
基金项目:四川省科技厅创新团队资助项目(编号:2017TD0029)
An exploration on the operation skills of natural orifice specimen extraction surgery for transanal eversion resection of low rectal cancer under laparoscope
ZHAO Xiao-fang, FU Chuan-chuan, ZHENG Yang-chun, et al.
Operating Room, Sichuan Cancer Hospital, Chengdu 610041, China
Abstract:
[Abstract] Objective To explore the operation skills of natural orifice specimen extraction surgery(NOSES) for transanal eversion resection of low rectal cancer under laparoscope. Methods A total of 67 patients with low rectal cancer who underwent NOSES for transanal eversion resection of low rectal cancer under laparoscope in Sichuan Cancer Hospital from January 2017 to December 2021 were selected. The operation time, intraoperative blood loss, postoperative complications, hospital stay, tumor recurrence and metastasis of the patients were analyzed. Results All the 67 patients in this group were successfully operated, and none of them was converted to laparotomy. Among them, 3 patients underwent unilateral lateral lymph node dissection at the same time, and 43 patients(64.2%) underwent prophylactic ileostomy during the operation. The operation time ranged from 200 to 590 minutes, with an average of 320.1 minutes. Intraoperative blood loss was 5 to 300 ml, with an average of 64.3 ml. No case of abdominal contamination occurred. After surgery, the average time to exhaust gas through the anus or stoma was 21.9 hours(1-88 hours). Postoperative anastomotic leakage occurred in 1 case, urinary retention in 3 cases, and incomplete intestinal obstruction in 5 cases, and all the patients with these complications were cured by conservative treatments. The average postoperative hospital stay was 10.6 days(7-26 days). After surgery, the patients were followed up until June 2022, and pelvic recurrence was found in 1 case and distant metastasis in 5 cases. Conclusion NOSES for transanal eversion resection of low rectal cancer under laparoscope has the advantages of less trauma, quick recovery and good curative effect. As long as the indications are strictly controlled before surgery, and the aseptic and tumor-free principles are strictly observed, and the key operating skills are mastered, the abdominal cavity contamination can be effectively avoided and the risk of iatrogenic tumor spread can be reduced.
Key words:  Laparoscope  Low rectal cancer  Natural orifice specimen extraction surgery(NOSES)  Operation skills