Watanabe Y, Sato M, Tokui K, Ueda S, Kawachi K
Second Department of Surgery, Ehime University, Japan.
Hepatogastroenterology. 1999 Mar-Apr;46(26):909-13.
BACKGROUND/AIMS: To investigate the feasibility of a technique with minimal skin incision, while retaining a rate of cure and safety equivalent to conventional rectal amputation, by making use of the advantages of laparoscopic procedures, we performed a minimally invasive laparoscopic rectal amputation.
Six patients suffering from rectal cancer with cardiac and/or respiratory disorders underwent laparoscope-assisted rectal amputation. The procedure was performed in three steps: 1) sacral approach, 2) laparoscope-assisted abdominal approach under CO2 insufflation, and 3) extracorporeal resection of the inferior mesenteric artery (IMA) and stoma making without CO2 insufflation.
Intra-operative cardiopulmonary functions were maintained within normal range during CO2 insufflation. Although all patients had severe respiratory or cardiac disorder or diabetes mellitus, no complications were observed during and after surgery. The post-operative course was uneventful for our patients, each of whom could eat on the first post-operative day and walk on the third post-operative day. All patients were discharged from the hospital uneventfully.
Laparoscope-assisted rectal amputation is technically feasible, adequate tumor excision can be achieved with it and post-operative recovery is improved. Sacrolaparoscopic rectal amputation appears to be a safe alternative procedure for patients with rectal cancer and even with severe cardiopulmonary disorders.
背景/目的：为了利用腹腔镜手术的优势，研究一种皮肤切口最小化的技术的可行性，同时保持与传统直肠切除术相当的治愈率和安全性，我们开展了微创腹腔镜直肠切除术。
6例患有心脏和/或呼吸系统疾病的直肠癌患者接受了腹腔镜辅助直肠切除术。该手术分三步进行：1）经骶骨入路；2）在二氧化碳气腹下进行腹腔镜辅助腹部入路；3）在无二氧化碳气腹的情况下体外切除肠系膜下动脉（IMA）并造口。
在二氧化碳气腹期间，术中心肺功能维持在正常范围内。尽管所有患者都患有严重的呼吸系统或心脏疾病或糖尿病，但手术期间及术后均未观察到并发症。我们的患者术后恢复顺利，每位患者术后第一天即可进食，第三天即可行走。所有患者均顺利出院。
腹腔镜辅助直肠切除术在技术上是可行的，能够实现充分的肿瘤切除，并且术后恢复得到改善。骶腹腔镜直肠切除术似乎是直肠癌患者甚至患有严重心肺疾病患者的一种安全替代手术。
