Du Xiaohui, Xing Xiaowei
Department of general surgery, general hospital of PLA, Beijing 100853, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018;21(4):395-398.
With popularity of robotic surgery system, robotic rectal cancer surgery is increasing. Precautionary measures of different perioperative periods should be taken to reduce the risk for anastomotic leakage. First, the general condition of patients should be acquainted and improved, and the risk for anastomotic leakage should be evaluated preoperatively. Preoperative neoadjuvant chemoradiotherapy may not increase the risk for anastomotic leakage after rectal surgery. The impact of routine bowel preparation to prevent anastomotic leakage needs to be verified further. Second, surgical techniques are crucial to prevent anastomotic leakage. Surgical procedures and resected intestines should be carefully selected. Careful surgery, adequate mobilization of the proximal colon, anastomosis with direct view will be required. Tension-free anastomosis and sufficient blood supply are necessary. We selected low ligation of the inferior mesenteric artery and preservation of the left colic artery in our routine practice to guarantee sufficient blood supply of the anastomosis site. Using the robotic Da Vinci system, indocyanine green(ICG) florescence can identify the collateral vessels in the inferior mesenteric artery zone. For patients with high risk for anastomotic leakage, pelvic drains, defunctioning stoma, and rectal tube may be useful to prevent anastomotic leakage. Early diagnosis and treatment are crucial for patients with anastomotic leakage.
随着机器人手术系统的普及，机器人直肠癌手术正在增加。应采取不同围手术期的预防措施以降低吻合口漏的风险。首先，应了解并改善患者的一般状况，并在术前评估吻合口漏的风险。术前新辅助放化疗可能不会增加直肠手术后吻合口漏的风险。常规肠道准备对预防吻合口漏的影响需要进一步验证。其次，手术技术对于预防吻合口漏至关重要。应仔细选择手术方式和切除的肠段。需要进行仔细的手术、充分游离近端结肠、直视下吻合。无张力吻合和充足的血供是必要的。我们在常规实践中选择低位结扎肠系膜下动脉并保留左结肠动脉，以保证吻合部位有充足的血供。使用机器人达芬奇系统，吲哚菁绿（ICG）荧光可以识别肠系膜下动脉区域的侧支血管。对于吻合口漏高危患者，盆腔引流、造口去功能化和直肠管可能有助于预防吻合口漏。对于吻合口漏患者，早期诊断和治疗至关重要。
