经肛门全直肠系膜切除术中自制气压平衡装置的使用体会
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摘要
目的总结在经肛门全直肠系膜切除术中使用自制通气装置的体会。方法在2016年11月至2017年4月完成的5例经肛门全直肠系膜切除手术中,当与腹腔贯通时使用自制的通气装置维持腹腔压力平衡,并分析5例患者的临床资料。结果 5例患者均顺利完成手术,无中转开腹,平均手术时间(206.0±9.5)min,其中1例在完全TaTME下完成,术中平均出血量(64.0±27.3)mL,切除肠管长度平均(17.4±1.3)cm,淋巴结清扫数目平均(16.8±1.2)枚,下切缘距肿瘤长度平均(2.5±0.3)cm,均符合全直肠系膜切除标准。术后肛门或造口排气时间(21.8±4.9)h,恢复进食时间(11.2±2.6)h,术后住院时间(5.2±0.7)d。未出现术后腹腔出血、肠瘘、腹腔感染或肠梗阻等并发症。结论在经肛门全直肠系膜切除术中使用自制通气装置可获得稳定的操作空间和视野,有利于手术操作,效果切确。
Objective To summarize the experience of self-made breather in transanal total mesorectal excision(TaTME). Methods From November 2016 to April 2017, 5 cases of transanal total mesorectal excision were performed. The abdominal pressure balance was maintained by using self-made ventilation device when penetrating the abdominal cavity. The clinical data of these 5 cases were analyzed.Results All operations went smoothly without abdominal incision but only 1 patient underwent pureTaTME among 5 cases. The operation time was(206.0±9.5) min, the amout of bleeding was(64.0±27.3) mL, the length of removal intestinal canal was(17.4±1.3) cm, the amount of lymph node dissection was(16.8±1.2), the length of lower incisal margin was(2.5±0.3) cm, the exhaust time was(21.8±4.9) h,the fasting time was(11.2±2.6) h and the length of stay after operation was(5.2±0.7) d. There was no bleeding, intestinal fistula, abdominal infection and intestinal obstruction. Conclusion Self-made breather was useful in transanal total mesorectal excision. It can help to get stable working place and operation view.
Objective To summarize the experience of self-made breather in transanal total mesorectal excision(TaTME). Methods From November 2016 to April 2017, 5 cases of transanal total mesorectal excision were performed. The abdominal pressure balance was maintained by using self-made ventilation device when penetrating the abdominal cavity. The clinical data of these 5 cases were analyzed.Results All operations went smoothly without abdominal incision but only 1 patient underwent pureTaTME among 5 cases. The operation time was(206.0±9.5) min, the amout of bleeding was(64.0±27.3) mL, the length of removal intestinal canal was(17.4±1.3) cm, the amount of lymph node dissection was(16.8±1.2), the length of lower incisal margin was(2.5±0.3) cm, the exhaust time was(21.8±4.9) h,the fasting time was(11.2±2.6) h and the length of stay after operation was(5.2±0.7) d. There was no bleeding, intestinal fistula, abdominal infection and intestinal obstruction. Conclusion Self-made breather was useful in transanal total mesorectal excision. It can help to get stable working place and operation view.
引文
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[3]Heald RJ,Santiago I,Pares O,et al.The Perfect Total Mesorectal Excision Obviates the Need for Anything Else in the Management of Most Rectal Cancers[J].Clin Colon Rectal Surg,2017,30(5):324-332.
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[6]Marks JH,Myers EA,Zeger EL,et al.Long-term outcomes by a transanal approach to total mesorectal excision for rectal cancer[J].Surg Endosc,2017,31(12):5248-5257.
[7]李会晨,付文政,张锡朋.经肛门全直肠系膜切除术治疗低位直肠癌[J/CD].中华结直肠疾病电子杂志,2014,3(2):61-62.
[8]Thomsen MH,Ovesen H,Eriksen JR.Combined laparoscopic and transanal total mesorectal excision for rectal cancer:Initial experience and early results[J].J Minim Access Surg,2017,13(2):113-117.
[9]叶景旺,黄彬,童卫东,等.完全经肛门或联合腹腔镜的全直肠系膜切除术11例临床分析[J].中华胃肠外科杂志,2015,18(8):821-825.
[10]张忠涛.完全经肛门全直肠系膜切除——腹腔镜直肠癌手术未来的方向?[J].中国实用外科杂志,2015,35(8):844-846.
[11]Uematsu D,Akiyama G,Sugihara T,et al.Complete Transanal Total Mesorectal Excision for Lower Rectal Cancer[J].Dis Colon Rectum,2017,60(8):872-873.
[2]童卫东,赖晓东.经肛门全直肠系膜切除术技术平台的建立与面临的问题[J].中华胃肠外科杂志,2015,18(5):430-432.
[3]Heald RJ,Santiago I,Pares O,et al.The Perfect Total Mesorectal Excision Obviates the Need for Anything Else in the Management of Most Rectal Cancers[J].Clin Colon Rectal Surg,2017,30(5):324-332.
[4]Heald RJ,Ryall RD.Recurrence and survival after total mesorectal excision for rectal cancer[J].Lancet,1986,1(8496):1479-1482.
[5]池畔.对“腹腔镜辅助经肛门全直肠系膜切除术治疗中低位直肠癌的临床疗效”的点评[J].中华消化外科杂志,2017,16(7):701.
[6]Marks JH,Myers EA,Zeger EL,et al.Long-term outcomes by a transanal approach to total mesorectal excision for rectal cancer[J].Surg Endosc,2017,31(12):5248-5257.
[7]李会晨,付文政,张锡朋.经肛门全直肠系膜切除术治疗低位直肠癌[J/CD].中华结直肠疾病电子杂志,2014,3(2):61-62.
[8]Thomsen MH,Ovesen H,Eriksen JR.Combined laparoscopic and transanal total mesorectal excision for rectal cancer:Initial experience and early results[J].J Minim Access Surg,2017,13(2):113-117.
[9]叶景旺,黄彬,童卫东,等.完全经肛门或联合腹腔镜的全直肠系膜切除术11例临床分析[J].中华胃肠外科杂志,2015,18(8):821-825.
[10]张忠涛.完全经肛门全直肠系膜切除——腹腔镜直肠癌手术未来的方向?[J].中国实用外科杂志,2015,35(8):844-846.
[11]Uematsu D,Akiyama G,Sugihara T,et al.Complete Transanal Total Mesorectal Excision for Lower Rectal Cancer[J].Dis Colon Rectum,2017,60(8):872-873.