Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
Dis Colon Rectum. 2014 Feb;57(2):251. doi: 10.1097/DCR.0000000000000047.
This video demonstrates a laparoscopic abdominal perineal resection for a fixed 4.8-cm mass involving the posterior and left rectal walls and left puborectalis, 2 cm from the anal verge (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A127). We detail the steps of the procedure, all completed in lithotomy, including lateral-to-medial dissection; identification and protection of the left ureter and presacral nerves; division of the inferior mesenteric artery; medial-to-lateral dissection, with meeting the previous dissection plane; total mesorectal excision and pelvic dissection; perineal dissection and layered closure; and abdominal inspection and colostomy creation. Total operative time was 181 minutes. The specimen total mesorectal excision was complete with a negative circumferential radial margin (greater than 1 cm). Final pathology was T3N2M0.
这段视频演示了一例腹腔镜下腹会阴联合切除术，用于治疗一处固定的 4.8 厘米大小的肿块，该肿块累及直肠后壁和左侧肛提肌，距离肛门边缘 2 厘米（见视频，补充数字内容 1，http://links.lww.com/DCR/A127）。我们详细介绍了手术步骤，所有步骤均在截石位下完成，包括从外侧向内侧分离；识别和保护左侧输尿管和骶前神经；肠系膜下动脉的分离；从内侧向外侧分离，与之前的分离平面相遇；全直肠系膜切除和盆腔解剖；会阴解剖和分层关闭；以及腹部检查和造口术。总手术时间为 181 分钟。标本的全直肠系膜切除完整，环周切缘阴性（大于 1 厘米）。最终病理为 T3N2M0。
