腔镜切割荷包吻合器在腹腔镜结直肠癌手术中的应用体会  

Experiences with the application of endoscopic linear-cutting purse-string stapler in laparoscopic colorectal cancer surgery

作　　者：张毅勋[1] 关旭 焦帅 张鑫[1] 刘茂希 高晟[1] 冯毅[1] 王文渊[1] 江波[1] 白文启[1] 刘海义[1] 王锡山 Yixun Zhang;Xu Guan;Shuai Jiao;Xin Zhang;Maoxi Liu;Sheng Gao;Yi Feng;Wenyuan Wang;Bo Jiang;Wenqi Bai;Haiyi Liu;Xishan Wang(Department of Colorectal Surgery,Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China;Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center of Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院结直肠外科,太原030013 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021

出　　处：《中华结直肠疾病电子杂志》2024年第2期148-152,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家重点研发计划青年科学家项目(2022YFC2505700)。

摘　　要：目的结直肠手术中进行腔镜下荷包缝合一直是手术操作的难点,尤其是经自然腔道取标本手术(NOSES)。同时结肠、直肠吻合口处形成的“危险三角区”又是增加吻合口漏的主要因素。腔镜切割荷包吻合器的临床应用可以有效解决上述技术难题。方法本研究纳入5例行根治性手术的结直肠癌患者,包括4例直肠癌和1例乙状结肠癌。所有患者手术消化道重建过程中,乙状结肠荷包缝合及抵钉座固定步骤均使用腔镜切割荷包吻合器。结果患者平均年龄为(54.4±8.6)岁,患者平均BMI为(24.7±2.9)kg/m^(2)。4例患者行腹腔镜直肠癌根治+预防性末端回肠双腔造口术,1例患者行NOSES Ⅳ式。平均手术时间为(123.60±15.37)min,平均术中出血量为(98±36)mL,平均术后住院天数为(9.4±0.5)天。所有患者围术期均未出现并发症。结论腔镜直线荷包缝合器降低了全腔镜下乙状结肠与直肠消化道重建的操作难度。该设备的临床应用无论是对于常规腹腔镜手术,亦或是NOSES手术,都具有很好的临床价值与推广潜力。ObjectiveIn colorectal surgery, performing laparoscopic purse-string suture has always been a technical challenge, especially in natural orifice specimen extraction surgery (NOSES). Additionally, the formation of the "dangerous triangle area" at the colonic-rectal anastomosis site is a major factor contributing to anastomotic leakage. The clinical application of endoscopic linear-cutting purse-string stapler can effectively address these technical challenges.MethodsThis study included 5 patients with colorectal cancer who underwent radical surgery, including 4 cases of rectal cancer and 1 case of sigmoid colon cancer. In all patients, the process of colonic anastomosis and stapler fixation of the anvil during digestive tract reconstruction utilized endoscopic linear-cutting purse-string stapler.ResultsThe average age of the patients was (54.4±8.6) years, and the average BMI was (24.7±2.9) kg/m^(2). Four patients underwent laparoscopic radical rectal cancer surgery with ileostomy, while one patient underwent NOSES Ⅳ. The average operation time was (123.60±15.37) minutes, the average intraoperative blood loss was (98±36) mL, and the average postoperative hospital stay was (9.4±0.5) days. No perioperative complications occurred in any of the patients.ConclusionThe endoscopic linear-cutting purse-string stapler reduces the difficulty of digestive tract reconstruction in total laparoscopic sigmoid colon and rectal surgery. Its clinical application has significant value and potential for promotion, whether in routine laparoscopic surgery or NOSES.

关 键 词：结直肠肿瘤 腹腔镜 腔镜切割荷包吻合器 经自然腔道取标本手术 

分 类 号：R735.34[医药卫生—肿瘤]