Kessler Hermann, Hohenberger Werner
Department of Surgery, University of Erlangen-Nürnberg, Erlangen, Germany.
Dis Colon Rectum. 2005 Apr;48(4):860-1. doi: 10.1007/s10350-005-0036-6.
Total colectomy is the preferred surgical option in proven slow-transit constipation. With advances in technology and instrumentation, laparoscopic total colectomy has become feasible.
After a mechanical bowel preparation, the patient is placed in a modified lithotomy position and pneumoperitoneum is established. Using a subumbilical 12-mm trocar the camera is inserted. Two further 12-mm and 5-mm trocars, each, are used for access to the peritoneal cavity. In an approach from medial to lateral, ileocolic, middle colic vessels and the inferior mesenteric artery are divided. Medial mobilization is completed before the sigmoid is freed up laterally. The lateral mobilization continues orally to the descending, transverse, and ascending colon with the omentum being separated from the transverse colon completely. The mesorectum is divided using the harmonic scalpel, and the upper rectum is transected with either one or two passes of the endoscopic linear cutting stapler. The colon is exteriorized through a 5-cm Pfannenstiel incision. The terminal ileum is transected extracorporeally. After pneumoperitoneum has been reestablished, the ileorectal anastomosis is performed laparoscopically using a double-stapling technique.
The video reports about a 56-year-old lady who had been suffering from chronic constipation since childhood and had become dependent on laxatives. A dolichocolon had been found in barium enema. A prolonged colonic passage was proven in an x-ray transit study. There were no intraoperative or postoperative complications. After surgery, first bowel movements occurred on the second day and the patient was discharged from the hospital on the sixth postoperative day.
Laparoscopic total colectomy is a safe, feasible operation for slow transit constipation. With fast recovery and short length of stay it may become an attractive surgical approach.
对于确诊的慢传输型便秘，全结肠切除术是首选的手术方式。随着技术和器械的进步，腹腔镜全结肠切除术已成为可行的手术方式。
在进行机械性肠道准备后，患者取改良截石位并建立气腹。通过脐下12毫米套管针插入摄像头。另外分别使用两个12毫米和5毫米的套管针进入腹腔。采用从内侧到外侧的入路，分别离断肠结肠、中结肠血管和肠系膜下动脉。在乙状结肠向外侧游离之前先完成内侧游离。外侧游离继续向上至降结肠、横结肠和升结肠，同时将大网膜与横结肠完全分离。使用超声刀离断直肠系膜，并用内镜直线切割吻合器一至两次击发横断直肠上段。通过一个5厘米的耻骨上横切口将结肠拖出体外。在体外横断回肠末端。重新建立气腹后，采用双吻合器技术在腹腔镜下进行回直肠吻合。
视频报道了一位56岁女性，她自幼患有慢性便秘，已对泻药产生依赖。钡剂灌肠检查发现有冗长结肠。X线传输研究证实结肠传输时间延长。术中及术后均无并发症。术后第二天首次排便，术后第六天患者出院。
腹腔镜全结肠切除术对于慢传输型便秘是一种安全、可行的手术方式。因其恢复快、住院时间短，可能会成为一种有吸引力的手术方法。
