Department of Gastroenterological Surgery, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
Surg Today. 2012 Sep;42(9):909-12. doi: 10.1007/s00595-012-0215-8. Epub 2012 Jun 9.
We herein report a case in which a rectal gastrointestinal stromal tumor (GIST) was resected transvaginally. The patient, a 45-year-old female, had a rectal GIST on the anterior wall of the lower rectum. The tumor was within 6 cm of the anal verge, a location which would normally require performing an ultra-low anterior resection using the Double Staple Technique, and a diverting stoma. To minimize the invasiveness of treatment and to reduce the postoperative morbidity, a transvaginal resection was performed. Under general anesthesia, the posterior vaginal mucosa was incised vertically. The tumor was then excised en bloc with the overlying rectovaginal septum and rectal mesenchymal tissue. The defect was repaired primarily, and a diverting stoma was not required. The procedure was uncomplicated, and the patient was discharged home with an intact anal sphincter function and no abdominal incisions. In female patients, transvaginal resection of low anterior rectal lesions may provide a minimally invasive alternative to the traditional ultra-low anterior resection.
我们在此报告一例经阴道直肠胃肠道间质瘤(GIST)切除术。患者为 45 岁女性,于直肠下段前壁发现直肠 GIST。肿瘤距肛门 6cm 以内,按常规需要采用双吻合器技术行超低位前切除术,并需行预防性造口术。为了减少治疗的侵袭性和降低术后发病率,我们选择行经阴道切除术。在全身麻醉下,垂直切开阴道后壁黏膜。然后整块切除肿瘤及其上方的直肠阴道隔和直肠系膜组织。缺损直接修复,无需预防性造口术。手术过程简单,患者出院时肛门括约肌功能完整,腹部无切口。对于女性患者,经阴道切除低位前直肠病变可能为传统超低位前切除术提供一种微创选择。