Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan.
Oncol Rep. 2010 Jul;24(1):25-30. doi: 10.3892/or_00000824.
During the initial emergency operation, a temporary loop colostomy (TLC) was constructed at the oral border of the region for subsequent radical resection. Then, radical surgery was performed by hybrid 2-port HALS (Mukai's operation) using the TLC as the hand access site. Left hemicolectomy was done in three patients, sigmoidectomy in two cases, low anterior resection in one case, and Hartmann's operation in one case. Radical surgery was not done in one patient with multiple distant metastases. The mean operating time was 3 h and 7 min (ranging from 1 h and 55 min to 3 h and 47 min), the mean blood loss was 146.4 ml (7-354 ml), the mean duration from TLC to HALS was 11.3 days (8-16 days), and the mean hospital stay after HALS was 13.9 days (9-20 days). Mild wound infection occurred postoperatively in 2/7 patients and ileus occurred in one patient. However, there was no anastomotic leakage/stricture or conversion to conventional laparotomy. These results suggest that 2-stage treatment (Mukai's method with Mukai's operation) is also applicable to large obstructing left colon or rectal cancers. This method is safe, less invasive, and achieves excellent results, including a good cosmetic outcome.
在初始急救手术中，在区域的口腔边界处构建了临时回路结肠造口术（TLC），以便随后进行根治性切除术。然后，通过混合两孔 HALS（Mukai 手术）使用 TLC 作为手进入部位进行根治性手术。三名患者行左半结肠切除术，两名患者行乙状结肠切除术，一名患者行低位前切除术，一名患者行 Hartmann 手术。一名有多处远处转移的患者未进行根治性手术。平均手术时间为 3 小时 7 分钟（1 小时 55 分钟至 3 小时 47 分钟），平均出血量为 146.4 毫升（7-354 毫升），从 TLC 到 HALS 的平均时间为 11.3 天（8-16 天），HALS 后平均住院时间为 13.9 天（9-20 天）。7 名患者中有 2 名术后出现轻度伤口感染，1 名患者出现肠梗阻。然而，没有吻合口漏/狭窄或转为传统剖腹手术。这些结果表明，两阶段治疗（Mukai 方法联合 Mukai 手术）也适用于大型左结肠或直肠梗阻性癌。该方法安全、微创，可获得良好的结果，包括良好的美容效果。
