用于早期高位直肠肿瘤（T0-T1，N0病变）的机器人经肛门显微手术：10例患者的病例系列
Robotic transanal microsurgery for high early rectal neoplasia (T0-T1, N0 lesions), case series of 10 patients.
作者信息
Arnott Suzanne, Skancke Matthew, Obias Vincent
机构信息
George Washington University School of Medicine and Health Sciences, Washington, DC, 20037, USA.
Department of Colorectal Surgery at the George Washington University Hospital, Washington, DC, 20037, USA.
出版信息
Int J Med Robot. 2018 Dec;14(6):e1956. doi: 10.1002/rcs.1956. Epub 2018 Sep 26.
PURPOSE/BACKGROUND: In 2017, an estimated 39 910 people will receive a new diagnosis of rectal cancer. Current surgical guidelines limit transanal excision of early rectal neoplasia to 8 cm from the anal verge. We report that R0 resection of higher rectal cancers is possible using transanal robotic microsurgery.
METHODS/INTERVENTIONS: Ten cases of robotic assisted transanal surgery for early stage disease (T0-T1, N0) between 2013 and 2016 were reviewed.
RESULTS/OUTCOMES: All cases were diagnosed preoperatively with colonoscopy, and the average distance from the anal verge was 11.1 cm. The average operative time was 167 minutes, and the average blood loss was 37.5 cc. Four cases required intraoperative conversion; one conversion required robotic abdominal access to repair a proctotomy. All margins were histologically negative, and 6-month follow-up showed no recurrences.
CONCLUSION/DISCUSSION: Transanal robotic surgery may provide the colorectal surgeon a method to address rectal lesions farther from the anal verge.
目的/背景：2017年，预计有39910人将被新诊断为直肠癌。目前的手术指南将早期直肠肿瘤经肛门切除术的范围限制在距肛缘8厘米以内。我们报告了使用经肛门机器人显微手术对高位直肠癌进行R0切除是可行的。
方法/干预措施：回顾了2013年至2016年间10例机器人辅助经肛门手术治疗早期疾病（T0-T1，N0）的病例。
结果/结局：所有病例术前均经结肠镜检查确诊，距肛缘平均距离为11.1厘米。平均手术时间为167分钟，平均失血量为37.5毫升。4例需要术中中转；1例中转需要机器人辅助经腹入路修复直肠切开术。所有切缘组织学检查均为阴性，6个月随访未见复发。
结论/讨论：经肛门机器人手术可能为结直肠外科医生提供一种处理距肛缘较远的直肠病变的方法。
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