Lone-Star会阴暴露技术在直肠癌腹会阴手术中的应用  

Lone-Star perineal exposure technique in abdominoperineal resection for rectal cancer

作　　者：马军[1] 汤代彬[1] 赵春霞[1] 张亚铭[1] 高斌[1] Ma Jun;Tang Daibin;Zhao Chunxia;Zhang Yaming;Gao Bin(Department of General Surgery,Anqing Municipal Hospital,Anqing 246000,China)

机构地区：[1]安庆市立医院普外科,安庆246000

出　　处：《国际外科学杂志》2024年第9期627-631,F0003,共6页International Journal of Surgery

基　　金：安徽省高校科研项目基金(2023AH050577);安庆市科技局科研项目基金(2023Z1001)。

摘　　要：目的分析Lone-Star会阴暴露技术实施经腹会阴直肠切除术(APR)的临床应用价值。方法采用回顾性描述研究的方法收集安庆市立医院自2020年1月—2024年7月接受经腹会阴直肠切除术的17例直肠癌患者的病历资料,其中男性13例,女性4例,年龄44~82岁,平均年龄(67.6±9.7)岁。会阴手术采用Lone-Star暴露技术(LSR),并由单人完成。采用荷包法关闭肛管,切开会阴皮肤和皮下组织后,放置Lone-Star盘状拉钩,用8个小拉钩向四周牵拉会阴切口,动态调整牵拉装置,以充分显露手术区域。结果所有患者均在腔镜下成功完成APR,其中15例手术由一人独立完成,仅2例因术中出血由2人完成。所有标本均无穿孔,环周切缘阴性。4例患者出现术后并发症,包括肺部感染1例、尿潴留1例、切口液化1例、造口分离1例,无二次手术病例,Clavien-Dindo并发症分级均<3级。结论LSR暴露技术的应用可能有助于直肠癌APR术中的会阴暴露,不增加手术并发症,提高手术效率,并实现单人会阴操作。Objective To analyse the clinical application value of Lone-Star perineal exposure technique in performing abdominal perineal resection(APR).Methods Conducted a retrospective review of 17 rectal cancer patients,including 13 males,4 females,aged from 44 to 82 years old,with the average age of(67.6±9.7)years who underwent APR at Anqing Municipal Hospital from January 2020 to July 2024.The Lone-Star retractor-assisted(LSR)exposure method was employed for the perineal operation.After incising the skin and subcutaneous tissue,a Lone-Star retractor was utilized,with eight small hooks used to extend the incision in multiple directions,facilitating the release of deep tissues.The hooks were dynamically adjusted to optimize surgical field exposure.Results All 17 patients were successfully underwent laparoscopic-assisted APR.Fifteen operations were independently performed by a single surgeon,while 2 required assistance for intraoperative arterial hemostasis.No perforations occurred,and all specimens had a negative circumferential resection margin(CRM).Postoperative complications were observed in 4 patients,including urinary retention in one,pulmonary infection in one,wound seroma in one,and stoma mucosal detachment in one,all of which were classified as Clavien-Dindo grade 3 or lower and cured.Conclusions The LSR exposure technique may significantly improve perineal exposure during APR for rectal cancer.It could potentially enhance intraoperative safety and efficiency,and facilitate single-operator surgery.

关 键 词：直肠肿瘤 手术 方法 经腹会阴直肠切除术 Lone-Star拉钩 

分 类 号：R735.37[医药卫生—肿瘤]