Seow-En Isaac, Chang Sheng-Chi, Ke Tao-Wei, Shen Ming-Yin, Chen Hong-Chang
1 Department of Colorectal Surgery, Singapore General Hospital, Singapore 2 Division of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan 3 Division of Colorectal Surgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan.
Dis Colon Rectum. 2021 May;64(5):e90-e93. doi: 10.1097/DCR.0000000000001922.
Natural orifice specimen extraction is the next step in minimally invasive colorectal surgery but can be technically challenging, with additional risks, especially for oncologic surgery. For several key reasons, sigmoid volvulus is well suited for natural orifice specimen extraction surgery. We describe our method and experience with double-stapled anastomosis transrectal natural orifice specimen extraction for sigmoid volvulus.
Using 3- or 4-port laparoscopy, the mesentery is separated from the long sigmoid loop. After the distal bowel is tied off and washed out, the rectum is completely transected and the proximal bowel delivered transrectally through a wound protector. Proximal transection is performed externally, and the circular stapler anvil is set before the bowel is returned into the abdominal cavity. The rectum stump is closed with an endoscopic linear stapler, and a circular-stapled anastomosis is performed.
After successful endoscopic decompression, 6 patients underwent elective laparoscopic sigmoidectomy with natural orifice specimen extraction for volvulus at China Medical University Hospital from 2015 to 2020. The median operative time was 179 minutes (range, 151-236 min). No intraoperative complications were encountered. The median postoperative length of stay was 4 days (range, 2-9 d). One patient experienced postoperative small-bowel ileus resulting in readmission. The median follow-up duration was 12 months (range, 2-49 mo). One recurrence of volvulus was recorded 27 months postsurgery.
Uncomplicated sigmoid volvulus can be treated effectively with sigmoidectomy and natural orifice specimen extraction. Surgeons who attempt this procedure should be well versed with conventional laparoscopy but do not necessarily need to be experienced with natural orifice specimen extraction for successful surgery.
经自然腔道标本取出术是微创结直肠手术的下一步发展方向，但该技术具有挑战性，且存在额外风险，尤其是在肿瘤手术中。由于几个关键原因，乙状结肠扭转非常适合经自然腔道标本取出术。我们描述了经直肠自然腔道标本取出术治疗乙状结肠扭转的双吻合器吻合方法及经验。
采用三孔或四孔腹腔镜，将肠系膜与冗长的乙状结肠袢分离。在结扎并冲洗远端肠管后，完全横断直肠，经伤口保护器经直肠将近端肠管拖出。在体外进行近端横断，在肠管回纳腹腔前放置圆形吻合器钉砧。用内镜直线切割吻合器关闭直肠残端，进行圆形吻合器吻合。
在中国医科大学附属第一医院，2015年至2020年期间，6例患者在内镜减压成功后，接受了择期腹腔镜乙状结肠切除术并经自然腔道取出标本治疗乙状结肠扭转。中位手术时间为179分钟（范围151 - 236分钟）。术中未发生并发症。中位术后住院时间为4天（范围2 - 9天）。1例患者术后发生小肠肠梗阻，再次入院。中位随访时间为12个月（范围2 - 49个月）。术后27个月记录到1例乙状结肠扭转复发。
单纯性乙状结肠扭转可通过乙状结肠切除术及经自然腔道标本取出术有效治疗。尝试该手术的外科医生应精通传统腹腔镜技术，但成功实施手术不一定需要有经自然腔道标本取出术的经验。
