Department of Surgery, Tokushima University, Tokushima, Japan.
Asian J Endosc Surg. 2020 Apr;13(2):242-245. doi: 10.1111/ases.12717. Epub 2019 Jun 19.
Urethral injury is one of the most important complications that can occur during transanal total mesorectal excision in male patients with rectal cancer. This report shows the usefulness of intraoperative X-ray fluoroscopy to avoid urethral injury associated with transanal total mesorectal excision.
Real-time navigation using fluoroscopy was performed to check the distance between the urethra and the dissection line at the level of the exposed rectourethral muscle, the middle level of the divided rectourethral muscle, and the level at which the prostate was identified.
The dissection was completed transanally up to the level of peritoneal reflection on the anterior side without urethral injury. Pathological examination confirmed that the circumferential resection margin was tumor free. This novel technique using intraoperative X-ray fluoroscopy is an easy-to-use approach that helps prevent urethral injury in male patient who undergo transanal total mesorectal excision for rectal cancer.
在男性直肠癌患者的经肛门全直肠系膜切除术中，尿道损伤是最常见的重要并发症之一。本报告显示术中 X 射线透视在避免与经肛门全直肠系膜切除术相关的尿道损伤方面的有用性。
使用透视术实时导航，以检查暴露的直肠尿道肌水平、分离的直肠尿道肌中间水平和前列腺识别水平的尿道与解剖线之间的距离。
在没有尿道损伤的情况下，经肛门完成了直到前侧腹膜反射的解剖。病理检查证实环周切除边缘无肿瘤。这种术中 X 射线透视的新技术是一种易于使用的方法，有助于预防接受经肛门全直肠系膜切除术治疗直肠癌的男性患者的尿道损伤。
