Uchikoshi F, Nishida T, Ueshima S, Nakahara M, Matsuda H
Department of Surgery, Osaka Police Hospital, 10-31 Kitayamacho Tennoji-ku, Osaka University, Graduate Schol of Medicine, 543-0035, Japan.
Tech Coloproctol. 2006 Mar;10(1):5-9; discussion 9. doi: 10.1007/s10151-006-0243-8. Epub 2006 Mar 15.
Transanal intersphincteric resection (ISR) was introduced and has been increasingly performed as an ultimate surgical treatment for extremely low rectal cancer. We considered that high quality and less invasive surgery could be achieved if ISR and laparoscopic surgery were combined.
Between December 2003 and June 2004, we performed laparoscope-assisted ISR for two patients with very low rectal cancer and total colectomy for two patients with ulcerative colitis complicated by colorectal cancer. In all patients, the transanal procedure was preceded by trans-abdominal laparoscopic rectal excision.
Preceding transanal dissection facilitated muscle layer-oriented curative dissection, and more importantly, made subsequent laparoscopic rectal excision effortless as a result of penetrating to the dissected pelvic cavity. All patients showed favorable recovery including postoperative anal function with no complication or recurrent disease.
This procedure is feasible and has favorable short-term results for radical treatment of very low rectal disease, while preserving anal function.
经肛门括约肌间切除术（ISR）已被引入并越来越多地作为极低位直肠癌的最终手术治疗方法。我们认为，如果将ISR与腹腔镜手术相结合，可以实现高质量且侵入性较小的手术。
在2003年12月至2004年6月期间，我们对2例极低位直肠癌患者进行了腹腔镜辅助ISR，对2例溃疡性结肠炎合并结直肠癌患者进行了全结肠切除术。所有患者均在经腹腹腔镜直肠切除术前进行经肛门手术。
先行经肛门解剖有助于以肌层为导向的根治性解剖，更重要的是，由于穿透至已解剖的盆腔，使得随后的腹腔镜直肠切除变得轻松。所有患者恢复良好，包括术后肛门功能，无并发症或疾病复发。
该手术对于极低位直肠疾病的根治性治疗是可行的，且具有良好的短期效果，同时保留肛门功能。
