经预防性造口标本取出的腹腔镜直肠癌前切除术——一种新的类NOTES方法  

The specimen extraction from the incision of protective ileostomy for laparoscopic low anterior resection: a feasible and innovative technique

作　　者：梁建伟[1] 周志祥[1] 刘骞[1] 周海涛[1] 王征[1] 张兴茂[1] 胡俊杰[1] 刘昕[1] 

机构地区：[1]中国医学科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》2015年第3期280-284,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

摘　　要：目的评价经预防性小肠造口切口标本取出的腹腔镜直肠癌前切除术的安全性和可行性。方法回顾分析13例中低直肠癌患者行术前同步放化疗,休息6至12周后行腹腔镜直肠癌低位前切除术联合末端回肠造口术,按TME原则行前切除术,远端肠管应用腔内型直线切割吻合器闭合切断,经右下腹纵切口3~4 cm将标本及近端直肠乙状结肠提出腹壁,清扫系膜淋巴结切除标本,镜下完成吻合,然后经右下腹切口完成预防性小肠造口。结果 13例患者均顺利完成手术,手术时间140 min(115~165 min),术中出血量27.7 ml(10~50 ml),进流食时间1.6 d(1~3 d),术后出院时间6.9 d(5~8 d),术后疼痛评分3.6(2.5~5),无手术死亡及严重并发症发生。结论在需行预防性造口的腹腔镜直肠癌前切除术患者中,经造口切口标本取出手术方式是安全可行的。Objective To evaluate the safety and feasibility of the specimen extraction from the incision of protective ileostomy for laparoscopic low anterior resection ( Lap-LAR ) .Metheods This study included a total of 13 patients with low rectal cancer who underwent a Lap-LAR with protective ileostomy in the right iliac fossa at the cancer hospital of Chinese Academy of Medical Sciences from March 2014 to January 2015.The clinical characteristics of all 13 patients were collected and analyzed and procedure of this technique was described.Result All the 13 operations were successfully accomplished.The mean operative times was 140min(115-165min) and mean intraoperative blood loss was 27.7ml(10-50ml).Of these 13 patients,the mean time to liquid diet recovery was 1.6d(1-3d),the mean visual analog scale(VAS)score was 3.6(2.5-5),and the mean postoperative hospital stay was6 .9 d(5-8d).There were no postoperative complications.Conclusions The specimen extraction from the incision of protective ileostomy for Lap-LAR is safe and feasible.As it can avoid another additional incision,it would be a possible option for diversion in laparoscopic Lap-LAR.

关 键 词：直肠肿瘤 腹腔镜 回肠造瘘术 

分 类 号：R735.37[医药卫生—肿瘤]