Kandeel Ahmed, Meguid Ahmed, Hawasli Abdelkader
St John Hospital and Medical Center, Michigan, MI, USA.
Surg Laparosc Endosc Percutan Tech. 2011 Feb;21(1):e21-3. doi: 10.1097/SLE.0b013e3182054f13.
In recent years, the standard of care for lower rectal tumors has developed to include a total mesorectal excision, which provides optimal long-term results. There has been debate with regard to the best approach for lower rectal tumors, conventional open versus less invasive procedures. As the trend toward less invasive surgical procedures progresses, similar complications, which are seen in open cases, are being encountered, such as the notorious presacral fascia bleed. These are small vessels, which are difficult to locate and control. Surgical literature suggests different methods during laparoscopic procedures. These include: placing lap pads and holding pressure, placing saline bag, placing tacks, using bone wax, and electrocautry at different settings. We present a case of a 57-year-old male, positive for lymph node disease, who underwent laparoscopic ultra low anterior resection with total mesorectal excision and protective loop ileostomy.
近年来，低位直肠肿瘤的治疗标准已发展为包括全直肠系膜切除术，该手术能提供最佳的长期治疗效果。关于低位直肠肿瘤的最佳手术方式，即传统开放手术与微创术式之间一直存在争议。随着外科手术向微创化发展的趋势不断推进，在开放手术中出现的类似并发症也在微创病例中出现，比如臭名昭著的骶前筋膜出血。这些是小血管，难以定位和控制。外科文献介绍了腹腔镜手术中的不同方法。这些方法包括：放置lap垫并施加压力、放置盐水袋、放置钉书钉、使用骨蜡以及在不同设置下进行电灼。我们报告一例57岁男性患者，淋巴结疾病呈阳性，该患者接受了腹腔镜超低位前切除术、全直肠系膜切除术及保护性回肠造口术。
