机器人辅助经肛全直肠系膜切除术的近期临床疗效  

Short-term outcomes of robot-assisted transanal total mesorectal excision

作　　者：叶景旺 田跃 赵松 王李 张勇 黄彬 李凡 刘宝华 童卫东 Ye Jingwang;Tian Yue;Zhao Song;Wang Li;Zhang Yong;Huang Bin;Li Fan;Liu Baohua;Tong Weidong(Department of General Surgery, Daping Hospital, Army Medical university, Chongqing 400042, China)

机构地区：[1]陆军军医大学大坪医院普通外科胃结直肠病区,重庆400042

出　　处：《中华胃肠外科杂志》2019年第3期267-272,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金项目(81270461、81570483、81770541);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：目的探讨达芬奇机器人辅助经肛全直肠系膜切除术(R-taTME)治疗直肠癌的近期疗效。方法回顾性分析2017年5月至2018年7月期间陆军军医大学大坪医院行达芬奇R-taTME手术的6例直肠癌患者的临床资料。手术步骤:患者取低平截石位,经肛距离肿瘤远端1~2 cm荷包缝合。安置自制经肛手术平台,连接机器人,自荷包远端0.5 cm环形切开直肠进入"神圣界面";沿脏壁筋膜之间"自下向上"分离;后方分离至第3骶椎位置,前方分离至腹膜反折。重新安置腹部戳卡并连接机器人,经腹腔进入乙状结肠系膜后Toldt间隙;向近端清扫D3淋巴结,向远端分离至与经肛部分会师;自肛门拖出标本、切除,乙状结肠断端与直肠远端或肛管行端端吻合。分析总结患者手术情况、术后病理情况以及近期疗效。标本直肠系膜完整度参照Nagtegaal标准评估为完整、近完整和不完整。吻合口漏根据国际直肠癌研究组严重程度分级标准进行分级评估。结果全组男性、女性各3例,年龄(62.6±2.6)岁,体质指数(20.5±3.0)kg/m2,肿瘤距肛缘距离(39.4±12.0)mm,肿瘤长径(33.6±9.2)mm。全组患者手术过程顺利,无中转,无术中及术后严重并发症及死亡发生。总手术时间为(245.8±24.2)min,术中两次设备对接时间为(21.2±2.6)min,机器人下经肛全直肠系膜解剖时间(72.3±15.2)min,术中出血量(86.7±59.9)ml,吻合口高度(16.0±6.1)mm。全组患者无术中意外出血、尿道损伤等并发症。全组患者术后大体标本长度(177.0±33.3)mm,术后标本直肠系膜完整度5例达到完整,1例为近完整,远切缘的长度(20.2±3.2)mm,近端、远端和环周切缘均为阴性。术后病理分期:T0N0期1例,T0N1期1例,T2N0期2例,T4N1期1例,T3N0期1例。前5例术后第1天均予以饮水,术后第2天进清流质饮食,术后3~6 d拔除引流管,术后住院时间5~7 d。第6例病例术后第3天出现B级吻合口漏,保守治愈。患者术后无死亡,无发�Objective To explore the feasibility and safety of Da Vinci robot-assisted transanal total mesorectal excision (taTME). Methods From May 2017 to July 2018, six rectal cancer patients underwent Da Vinci robot-assisted taTME at our hospital. The clinical data and short-term follow-up results were retrospectively analyzed. Surgical procedure: The patient was placed in a Trendelenburg lithotomy position and sutured with purse string 1-2 cm from the anus to the distal end of the tumor. A self-made platform for transanal surgery was installed and the robot was connected. The rectum was transected circumferentially 0.5 cm from the distal end of the purse. The robot entered the "holy plane" and separated upward between the visceral parietal fasciae to the level of the third sacrum posteriorly and the peritoneal refcection anteriorly. The abdominal trocar was repositioned and connected to the robot. Through the abdominal cavity, the Toldt space of the posterior sigmoid mesentery was entered, and the D3 lymph nodes were dissected proximally. Separation was performed distally to join the perineal approach. Specimen was pulled out from the anus and excised. The cut end of sigmoid colon was anastomosed with the distal rectum or anal canal. Operative status, postoperative pathology and short-term efficacy were analyzed. Mesorectum of specimen was evaluated as complete, near complete and incomplete according to the Nagtegaal criteria. Anastomotic leakage was evaluated according to the criteria developed by the International Rectal Cancer Research Group. Results All the 6 patients received Da Vinci robot-assisted taTME and sigmoid-anal anastomosis. In the 6 patients, 3 were male and 3 female;mean age was (62.6±2.6) years old;body mass index was (20.5±3.0) kg/m2;distance from tumor to anal edge was (39.4±12.0) mm;length of tumor was (33.6±9.2) mm. Four patients received neoadjuvant therapy before surgery. All the patients completed operations successfully without conversion to laparotomy perioperative, severe complications or

关 键 词：直肠肿瘤 机器人手术 经肛全直肠系膜切除术 经肛门手术 

分 类 号：R735.37[医药卫生—肿瘤]