机器人辅助经肛全直肠系膜切除术  

Robotic-assisted transanal total mesorectal excision for lower rectal cancer

作　　者：叶景旺[1] 田跃[1] 王李[1] 叶勇[1] 张勇[1] 李凡[1] 刘宝华[1] 童卫东[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所普通外科胃结直肠病区,重庆400042

出　　处：《中华胃肠外科杂志》2017年第8期900-903,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金项目（81270461,81570483）;重庆市自然科学基金重点项目（cstc2013jjB10025）;第三军医大学临床创新课题（2014YLC04）

摘　　要：目的 探讨Da Vinci机器人系统辅助经肛全直肠系膜切除术的可行性及安全性。 方法 报道重庆第三军医大学附属大坪医院胃肠外科于2017年5月31日进行的1例因低位直肠癌行Da Vinci机器人系统辅助经肛全直肠系膜切除、乙状结肠肛管吻合、回肠保护性造口手术患者的临床资料。 结果 63岁男性患者，体质指数19.1 kg/m2，直肠肿瘤距离肛缘4 cm，4 cm × 4 cm × 3 cm大小，中分化腺癌，肿瘤分期cT3N2M0，新辅助治疗后降期为ycT2N0M0。手术成功完成，手术时间250 min，术中出血量约100 ml，无术中相关并发症；术后未出现吻合口瘘、腹腔出血、肠梗阻或盆腔感染等并发症。术后病理结果提示，直肠系膜切除完整，环周切缘及远近肠段切缘均未见癌组织。结论 机器人系统应用于经肛全直肠系膜切除手术治疗直肠癌安全、可行。Objective To explore the availability of Da Vinci robotic-assisted transanal total mesorectal excision （taTME） for lower rectal cancer, which have been regarded as challenging situations in rectal cancer surgery. Methods The medical records of a patient who underwent robotic-assisted transanal total mesorectal excision, coloanal anastomosis and ileostomy for lower rectal cancer on May 31st 2017 were reported. Results The case was a sixty-three year-old male patient with a body mass index of 19.1 kg/m2. Preoperative examinations showed the tumor size was 4 cm×4 cm×3 cm. With a distance from the anal verge of 4 cm.The tumor was moderately differentiated and staged as cT3N2M0.taTME was performed successfully and the patient recovered quickly without any complications. The histological report showed a complete mesorectal excision with freee distal and circumferential margins. Conclusion Robotic-assisted taTME is available. Robotics may help to overcome technical difficulties.

关 键 词：直肠肿瘤 机器人手术 经肛门全直肠系膜切除 

分 类 号：R735.37[医药卫生—肿瘤]