Zhou Bao-Jun, Song Wei-Qing, Yan Qing-Hui, Cai Jian-Hui, Wang Feng-An, Liu Jin, Zhang Guo-Jian, Duan Guo-Qiang, Zhang Zhan-Xue
Department of Gastrointestinal Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China.
World J Gastroenterol. 2008 Jul 7;14(25):4065-9. doi: 10.3748/wjg.14.4065.
To investigate the feasibility and safety of monopolar electrocautery shovel (ES) in laparoscopic total mesorectal excision (TME) with anal sphincter preservation for rectal cancer in order to reduce the cost of the laparoscopic operation, and to compare ES with the ultrasonically activated scalpel (US).
Forty patients with rectal cancer, who underwent laparoscopic TME with anal sphincter preservation from June 2005 to June 2007, were randomly divided into ultrasonic scalpel group and monopolar ES group, prospectively. White blood cells (WBC) were measured before and after operation, operative time, blood loss, pelvic volume of drainage, time of anal exhaust, visual analogue scales (VAS) and surgery-related complications were recorded.
All the operations were successful; no one was converted to open procedure. No significant differences were observed in terms of preoperative and postoperative d 1 and d 3 WBC counts (P=0.493, P=0.375, P=0.559), operation time (P=0.235), blood loss (P=0.296), anal exhaust time (P=0.431), pelvic drainage volume and VAS in postoperative d 1 (P=0.431, P=0.426) and d 3 (P=0.844, P=0.617) between ES group and US group. The occurrence of surgery-related complications such as anastomotic leakage and wound infection was the same in the two groups.
ES is a safe and feasible tool as same as US used in laparoscopic TME with anal sphincter preservation for rectal cancer on the basis of the skillful laparoscopic technique and the complete understanding of laparoscopic pelvic anatomy. Application of ES can not only reduce the operation costs but also benefit the popularization of laparoscopic operation for rectal cancer patients.
探讨单极电灼铲（ES）在保留肛门括约肌的腹腔镜直肠癌全直肠系膜切除术（TME）中的可行性和安全性，以降低腹腔镜手术成本，并将ES与超声刀（US）进行比较。
前瞻性地将2005年6月至2007年6月期间接受保留肛门括约肌的腹腔镜TME的40例直肠癌患者随机分为超声刀组和单极ES组。测量手术前后的白细胞（WBC），记录手术时间、失血量、盆腔引流量、肛门排气时间、视觉模拟评分（VAS）和手术相关并发症。
所有手术均成功；无一例转为开放手术。ES组和US组在术前及术后第1天和第3天的WBC计数（P = 0.493，P = 0.375，P = 0.559）、手术时间（P = 0.235）、失血量（P = 0.296）、肛门排气时间（P = 0.431）、盆腔引流量以及术后第1天（P = 0.431，P = 0.426）和第3天（P = 0.844，P = 0.617）的VAS方面均未观察到显著差异。两组手术相关并发症如吻合口漏和伤口感染的发生率相同。
在熟练掌握腹腔镜技术并充分了解腹腔镜盆腔解剖结构的基础上，ES与US一样是用于保留肛门括约肌的腹腔镜直肠癌TME的安全可行工具。ES的应用不仅可以降低手术成本，还有利于直肠癌患者腹腔镜手术的推广。
