Fan Joe K M, Lo Christine S Y, Law Wai Lun
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
Surg Laparosc Endosc Percutan Tech. 2009 Oct;19(5):e210. doi: 10.1097/SLE.0b013e3181ab9454.
We report a 70-year-old lady who suffered from carcinoma of rectum with the lowest border of the tumor at 5 cm from the anal verge. Preoperative staging did not show any distant metastasis. Laparoscopic low anterior resection with total mesorectal excision was performed. The rectum was transected with endoscopic stapler and a double stapling anastomosis with a circular stapler was attempted. The spear of the circular stapler pierced through the rectal stump and attempt to remove the spear by pulling the suture attached to the spear failed. A pair of strong laparoscopic forceps was used in an attempt to remove the spear. The spear broke during the attempt of removal. The stapler was withdrawn through the anus with a pair of laparoscopic forceps following it. A new circular stapler was used and the tip was tied to a suture and cotton tape. The pair of forceps, which was still at the anus, was used to pull the cotton tape and the suture through the original perforation at the rectal stump. The tip of the spear of the new stapler was guided through the original perforation of the rectal stump. Double stapling was then performed and the patient recovered uneventfully. This case showed that stapler complication in laparoscopic surgery could be salvaged without conversion.
我们报告一位70岁女性，患有直肠癌，肿瘤最低边界距肛缘5厘米。术前分期未显示任何远处转移。行腹腔镜低位前切除术并完整切除直肠系膜。用内镜吻合器横断直肠，并尝试用圆形吻合器进行双吻合器吻合。圆形吻合器的钉砧穿透直肠残端，试图通过牵拉附着在钉砧上的缝线取出钉砧，但未成功。尝试用一对强力腹腔镜钳取出钉砧。在取出过程中钉砧断裂。用一对腹腔镜钳将吻合器经肛门取出。使用一个新的圆形吻合器，将其尖端系在一根缝线和棉带上。仍位于肛门处的那对钳子用于拉动棉带和缝线，使其穿过直肠残端原来的穿孔。新吻合器的钉砧尖端经直肠残端原来的穿孔引导。然后进行双吻合，患者顺利康复。该病例表明，腹腔镜手术中的吻合器并发症无需中转开腹即可挽救。
