Yamaguchi Takuya, Imai Minoru, Uematsu Dai
Department of Digestive Surgery, Mimihara General Hospital, Osaka, Japan.
Department of Colorectal Surgery, Saku Medical Center, Nagano, Japan.
Asian J Endosc Surg. 2017 May;10(2):219-222. doi: 10.1111/ases.12343.
We treated a 64-year-old man for rectal cancer with direct invasion to the seminal vesicles and no distant metastases by complete resection with laparoscopy and transanal minimally invasive surgery (TAMIS). We inserted the TAMIS device into the anal canal to above the anorectal ring and dissected to prostate level. High ligation of the inferior mesenteric artery and vein was performed by standard medial laparoscopy. The sigmoid and descending colon were mobilized, and in the postrectal space, we dissected to the space made by TAMIS. The membranous peritoneum was dissected on both sides of the rectum to the cul de sac. The peritoneum was dissected anterolaterally to reveal the seminal ducts, which were ligated and dissected on both sides. The seminal vesicles were dissected from the posterior wall of the bladder to the prostate level. The rectal specimen was now fully mobilized. Lower rectal resection with combined laparoscopy and TAMIS provided a better surgical plane than standard laparoscopy.
我们对一名64岁的直肠癌男性患者进行了治疗，该患者肿瘤直接侵犯精囊且无远处转移，采用腹腔镜和经肛门微创手术（TAMIS）进行了根治性切除。我们将TAMIS装置插入肛管至直肠肛门环上方，并解剖至前列腺水平。通过标准的内侧腹腔镜对肠系膜下动静脉进行高位结扎。游离乙状结肠和降结肠，在直肠后间隙，我们解剖至TAMIS形成的空间。在直肠两侧将腹膜切开至直肠子宫陷凹。在直肠前外侧切开腹膜以显露输精管，在两侧进行结扎和解剖。从膀胱后壁至前列腺水平解剖精囊。此时直肠标本已完全游离。腹腔镜联合TAMIS进行低位直肠切除比标准腹腔镜手术提供了更好的手术视野。
