Serra-Aracil Xavier, Mora-López Laura, Casalots Alex, Pericay Carles, Guerrero Raul, Navarro-Soto Salvador
Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain.
Pathology Service, Parc Taulí University Hospital, Universidad Autonoma de Barcelona, Sabadell, Barcelona, Spain.
Surg Endosc. 2016 Jan;30(1):346-54. doi: 10.1007/s00464-015-4170-5. Epub 2015 Mar 27.
Laparoscopic surgery for rectal TME achieves better patient recovery, lower morbidity, and shorter hospital stay than open surgery. However, in laparoscopic rectal surgery, the overall conversion rate is nearly 20%. Transanal TME combined with laparoscopy, known as Hybrid NOTES, is a less invasive procedure that provides adequate solutions to some of the limitations of rectal laparoscopy. Transanal TME via TEO with technical variants (intracorporeal resection and anastomosis, TEO review of the anastomosis) attempts to standardize and simplify the procedure.
Prospective observational study was used describe and assess the technique in terms of conversion to open surgery, overall morbidity, surgical site infection and hospital stay. The sample comprised consecutive patients diagnosed with rectal tumor less than 10 cm from the anal verge who were candidates for low anterior resection using TME (except T4). Demographic, surgical, postoperative, and pathological variables were analyzed, as well as morbidity rates.
From September 2012 to August 2014, 32 patients were included. The conversion rate was 0%. Overall morbidity was 31.3%, SSI rate was 9.4%, and mean hospital stay was 8 days. Oncological radical criteria were achieved with pathological parameters of 94% of complete TME and a median circumferential margin of 13 mm.
The introduction of technical variants of TEO for transanal resection can facilitate a procedure that requires extensive experience in transanal and laparoscopic surgery. Studies of sphincter function, quality of life, and long-term oncological outcome are now necessary.
与开放手术相比，腹腔镜直肠全系膜切除术可使患者恢复得更好，发病率更低，住院时间更短。然而，在腹腔镜直肠手术中，总体中转率接近20%。经肛门全直肠系膜切除术联合腹腔镜手术，即所谓的混合NOTES，是一种侵入性较小的手术，可有效解决直肠腹腔镜手术的一些局限性。通过经肛门内镜手术（TEO）进行经肛门全直肠系膜切除术，并采用技术变体（体内切除与吻合、TEO吻合口检查），旨在使该手术标准化并简化操作。
采用前瞻性观察性研究来描述和评估该技术在中转开放手术、总体发病率、手术部位感染和住院时间方面的情况。样本包括连续诊断为距肛缘小于10 cm的直肠肿瘤且适合采用全直肠系膜切除术（T4除外）进行低位前切除术的患者。分析了人口统计学、手术、术后和病理变量以及发病率。
2012年9月至2014年8月，共纳入32例患者。中转率为0%。总体发病率为31.3%，手术部位感染率为9.4%，平均住院时间为8天。94%的患者达到了完整全直肠系膜切除的病理参数，切缘周径中位数为13 mm，达到了肿瘤根治标准。
经肛门切除术引入TEO技术变体可促进一项需要经肛门和腹腔镜手术丰富经验的手术。目前有必要开展关于括约肌功能、生活质量和长期肿瘤学结局的研究。
