Shen Zhanlong, Ye Yingjiang, Jiang Kewei, Xie Qiwei, Yang Xiaodong, Shen Kai, Wang Shan
Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Mar;19(3):274-7.
To explore the feasibility and safety of transperineal single-port laparoscopy assisted exralevator abdominoperineal excision(TPSP-ELAPE).
Three cases (2 males and 1 female) who underwent TPSP-ELAPE at lithotomy position in the Peking University People's Hospital from January to February 2016 were analyzed retrospectively. The mean age was(55.3±7.2) years. Mean body mass index (BMI) was (23.0±1.3) kg/m(2). Mean distance between tumor and anal verge was (1.8±0.3) cm. Abdominal procedure was done firstly and then perineal procedure under lithotomy position. Abdominal procedure was performed by routine laparoscopy with 5 trocars. TPSP-ELAPE procedure was performed in perineal procedure. The perineal defect was closed by purse string, followed by spindle incision around the anus. Perianal skin and subcutaneous tissue was dissected until the junction between extra anal sphincter and levator ani muscle under direct vision. Perineal skin was sutured with double purse string by 2-0 prolene, and single port canal was placed inside in order to close perineal defect. The pneumoperitoneal pressure was set to 10 mmHg and laparoscopy and instrument was placed through the single-port canal. Space between isochioanal fossa and levator ani muscle was exposed by the contraction of laparoscopic clam. Lateral and posterior side was mobilized firstly. The anterior was dissected under the help of vaginal examination and contraction by abdominal group. The levator ani muscle was divided near the initial site, and negative resection margin was confirmed in the operation. Specimen was exteriorized through the perineum.
The mean intraoperative blood loss of three cases was (123.3±25.2) ml. The total operative time was (296.7±25.1) minutes. The time used by the perineal group was (196.7±20.8) minutes. The volume of drainage was (39.0±10.1) ml at the third day after operation. The time to first stoma output was (2.3±0.6) days. The perineal drainage removal time was (7.7±0.6) days. The circumferential resection margins were negative in all specimens, and there were no perioperative complications.
TPSP-ELAPE is feasible and safe, which could avoid turning over the patient and facilitate anesthesia. It follows the anatomic plane of open ELAPE procedure with minimally invasive advantage.
探讨经会阴单孔腹腔镜辅助超低位腹会阴联合切除术（TPSP-ELAPE）的可行性及安全性。
回顾性分析2016年1月至2月在北京大学人民医院接受截石位TPSP-ELAPE手术的3例患者（2例男性，1例女性）。平均年龄为（55.3±7.2）岁。平均体重指数（BMI）为（23.0±1.3）kg/m²。肿瘤距肛缘平均距离为（1.8±0.3）cm。先进行腹部手术，然后在截石位下进行会阴手术。腹部手术采用常规腹腔镜5孔法。会阴手术采用TPSP-ELAPE手术。会阴缺损采用荷包缝合关闭，然后在肛门周围做梭形切口。在直视下解剖肛周皮肤和皮下组织，直至肛门外括约肌与肛提肌交界处。用2-0普理灵双线荷包缝合会阴皮肤，并在内部放置单孔通道以关闭会阴缺损。气腹压力设定为10mmHg，通过单孔通道置入腹腔镜及器械。通过腹腔镜抓钳收缩暴露坐骨直肠窝与肛提肌之间的间隙。先游离外侧和后侧。在阴道检查及腹部组收缩的帮助下解剖前侧。在起始部位附近切断肛提肌，术中确认切缘阴性。标本经会阴取出。
3例患者术中平均出血量为（123.3±25.2）ml。总手术时间为（296.7±25.1）分钟。会阴组手术时间为（196.7±20.8）分钟。术后第3天引流量为（39.0±10.1）ml。首次排气时间为（2.3±0.6）天。会阴引流管拔除时间为（7.7±0.6）天。所有标本环切缘均为阴性，围手术期无并发症发生。
TPSP-ELAPE可行且安全，可避免患者翻身，便于麻醉。它遵循开放ELAPE手术的解剖平面，具有微创优势。
