改良反穿刺技术在全腹腔镜结直肠切除术中的应用价值  

Application Value of Improved Reverse Puncture Technique in Total Laparoscopic Colorectal Resection

作　　者：周懿[1] 侯克柱[1] 林辉[1] Zhou Yi;Hou Kezhu;Lin Hui(First Department of General Surgery, Shidong Hospital Yangpu District, Shanghai 200438, China)

机构地区：[1]上海市杨浦区市东医院普外一科,上海200438

出　　处：《中国微创外科杂志》2021年第4期313-316,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：杨浦区科委、卫健委课题(YP18M05)。

摘　　要：目的探讨改良反穿刺技术用于经自然腔道取出标本(nature orifice specimen extraction surgery,NOSES)的全腹腔镜结直肠切除术的安全性和可行性。方法回顾性分析2019年1~12月47例全腹腔镜结直肠切除术资料,病灶下缘距齿状线5 cm 5例,病灶位于直肠乙状结肠交界部、乙状结肠42例。肿瘤直径1.0~5.0 cm,平均2.8 cm。使用改良反穿刺技术,在腹腔镜下切开结肠壁,将抵钉座置入结肠,连接杆头端自结肠对系膜缘反向穿出,完成经肛门肠管吻合。结果47例手术均获得成功,无中转开腹,手术时间40~280 min(平均98 min),抵钉座置入时间2~5 min(平均3.4 min),术后住院时间7~18 d(平均9.8 d)。吻合口漏4例,保守治疗治愈,无其他并发症发生。术后随访3~12个月(平均7.9月),无并发症及复发。结论改良反穿刺技术应用在全腹腔镜结直肠切除术中安全可靠,降低腹腔镜手术难度。Objective To discuss the safety and feasibility of improved reverse puncture technique in total laparoscopic colorectal resection with natural orifice specimen extraction surgery(NOSES).Methods From January 2019 to December 2019,47 patients underwent total laparoscopic colorectal resection.The inferior margin of the lesion was 5 cm away from the dentate line in 5 cases,and the lesion was located at the rectosigmoid junction and sigmoid colon in 42 cases.The diameter of the tumor ranged from 1.0 cm to 5.0 cm,with an average of 2.8 cm.All the cases received improved reverse puncture technique.The colonic wall was cut under laparoscope,the stapler anvil was inserted into the colon,the cephalic end of the connecting rod was punctured reversely in the contralateral mesentery of the colon,and then the transanal anastomosis was completed.Results The operations were successfully completed in all the 47 cases.No patient was converted to open surgery.The operation time was 40-280 min(mean,98 min).The anvil placement time was 2-5 min(mean,3.4 min).The postoperative hospital stay was 7-18 d(mean,9.8 d).Four cases were found anastomotic leakage,which were relieved soon.No other complications occurred.During follow-ups for 3-12 months(mean,7.9 months),no long-term complication or recurrence was observed.Conclusions Total laparoscopic colorectal resection by using improved reverse puncture is a technically feasible and safe procedure.It also reduces the difficulty of laparoscopic surgery.

关 键 词：改良反穿刺技术 全腹腔镜手术 结直肠切除术 

分 类 号：R735.34[医药卫生—肿瘤]