Zhang X-M, Wang Z, Hou H-R, Zhou Z-X
Department of Gastrointestinal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
Tech Coloproctol. 2015 Jun;19(6):355-60. doi: 10.1007/s10151-015-1300-y. Epub 2015 Apr 4.
There is no consensus about the best technique to use for the surgical treatment for large rectal adenomas. The advent of laparoscopic surgery has led to the development of several new methods for the treatment of gastrointestinal tumors. This study was designed to introduce an innovative technique of totally laparoscopic resection with natural orifice specimen extraction (NOSE) for large rectal adenomas and to assess the feasibility and safety of the technique. Between February 2011 and January 2014, we performed totally laparoscopic resection with NOSE on 18 patients with a large rectal adenoma. This new technique was successful in all 18 patients. The average size of the adenoma was 4.2 cm. Mean operation time was 108.4 min, and mean intraoperative blood loss was 36.6 ml. The mean time to passing of the first flatus was 2.3 days, and the mean postoperative hospital stay was 7.2 days. Only one patient needed analgesics after the operation. All patients were able to walk within the first 2 days. There were no cases of morbidity and recurrence. Totally laparoscopic resection with NOSE appears to be suitable for selected patients with a large adenoma located in mid- or low rectum.
对于大型直肠腺瘤的手术治疗，尚无关于最佳技术的共识。腹腔镜手术的出现促使了几种治疗胃肠道肿瘤的新方法的发展。本研究旨在介绍一种用于大型直肠腺瘤的全腹腔镜切除联合经自然腔道取标本（NOSE）的创新技术，并评估该技术的可行性和安全性。在2011年2月至2014年1月期间，我们对18例大型直肠腺瘤患者进行了全腹腔镜切除联合NOSE手术。这项新技术在所有18例患者中均获成功。腺瘤的平均大小为4.2厘米。平均手术时间为108.4分钟，平均术中失血量为36.6毫升。首次排气的平均时间为2.3天，术后平均住院时间为7.2天。仅1例患者术后需要使用镇痛药。所有患者在术后前两天内均能行走。无并发症和复发病例。全腹腔镜切除联合NOSE似乎适用于部分位于直肠中下段的大型腺瘤患者。
