Hahnloser D, Cantero R, Salgado G, Dindo D, Rega D, Delrio P
Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland; Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.
Colorectal Dis. 2015 May;17(5):397-402. doi: 10.1111/codi.12866.
Transanal minimal invasive surgery (TAMIS) of rectal lesions is increasingly being used, but the technique is not yet standardized. The aims of this study were to evaluate peri-operative complications and long-term functional outcome of the technique and to analyse whether or not the rectal defect needs to be closed.
Consecutive patients undergoing TAMIS using the SILS port (Covidien) and standard laparoscopic instruments were studied.
Seventy-five patients (68% male) of mean age 67 (± 15) years underwent single-port transanal surgery at three different centres for 37 benign lesions and 38 low-risk cancers located at a mean of 6.4 ± 2.3 cm from the anal verge. The median operating time was 77 (25-245) min including a median time for resection of 36 (15-75) min and for closure of the rectal defect of 38 (9-105) min. The defect was closed in 53% using interrupted (75%) or a running suture (25%). Intra-operative complications occurred in six (8%) patients and postoperative morbidity was 19% with only one patient requiring reoperation for Grade IIIb local infection. There was no difference in the incidence of complications whether the rectal defect was closed or left open. Patients were discharged after 3.4 (1-21) days. At a median follow-up of 12.8 (2-29) months, the continence was normal (Vaizey score of 1.5; 0-16).
Transanal rectal resection can be safely and efficiently performed by means of a SILS port and standard laparoscopic instruments. The rectal defect may be left open and at 1 year continence is not compromised.
经肛门微创手术（TAMIS）治疗直肠病变的应用越来越广泛，但该技术尚未标准化。本研究的目的是评估该技术的围手术期并发症和长期功能结局，并分析直肠缺损是否需要关闭。
对连续使用SILS端口（柯惠公司）和标准腹腔镜器械进行TAMIS手术的患者进行研究。
75例患者（68%为男性），平均年龄67（±15）岁，在三个不同中心接受单孔经肛门手术，治疗37例良性病变和38例低风险癌症，病变平均距离肛缘6.4±2.3cm。中位手术时间为77（25 - 245）分钟，其中切除中位时间为36（15 - 75）分钟，直肠缺损关闭中位时间为38（9 - 105）分钟。53%的患者采用间断缝合（75%）或连续缝合（25%）关闭缺损。6例（8%）患者发生术中并发症，术后发病率为19%，仅1例患者因Ⅲb级局部感染需要再次手术。直肠缺损关闭或开放时并发症发生率无差异。患者术后3.4（1 - 21）天出院。中位随访12.8（2 - 29）个月时，控便功能正常（韦齐评分1.5；0 - 16）。
使用SILS端口和标准腹腔镜器械可安全、有效地进行经肛门直肠切除术。直肠缺损可以开放，1年后控便功能不受影响。
