Liu Yulin, Yu Peng, Li Han, Xia Lijian, Li Xiangmin, Zhang Meijuan, Cui Zhonghui, Chen Jingbo
Department of General Surgery, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China.
Department of Gastrointestinal Surgery, The Second People's Hospital of Lianyungang, Liaocheng, China.
BMC Surg. 2022 Apr 21;22(1):148. doi: 10.1186/s12893-022-01593-0.
Laparoscopic low anterior rectal resection is the most widely used surgical procedure for middle and low rectal cancer. The aim of this study was to investigate the feasibility and safety of the extracorporeal placement of the anvil in preserving the left colic artery in laparoscopic low anterior rectal resection without auxiliary incisions for transanal specimen retrieval in this research.
Clinical data and follow-up data of patients undergoing laparoscopic low anterior rectal resection from January 2017 to October 2020 were collected. The resections were modified such that the resisting nail holder was extracorporeally placed for the transanal exenteration of the specimen without using auxiliary abdominal incisions while preserving the left colic artery. By analyzing the data of anastomotic stenosis, anastomotic bleeding and anastomotic fistulas after surgery, the advantages and disadvantages of this surgical method for patients were clarified.
A total of 22 patients were enrolled. Five of 22 patients simultaneously underwent double-barrel terminal ileostomy. The postoperative exhaust time was 2-7 (median, 3) days. Postoperative anastomotic bleeding occurred in one patient, postoperative anastomotic fistula occurred in four patients, and postoperative anastomotic stenosis occurred in six patients. There were four patients with postoperative distant metastasis, of which three had concomitant local recurrence. Seventeen patients had no obvious symptoms or signs of recurrent metastases during follow-up appointments, and one died of liver failure.
Modified laparoscopic low anterior rectal resection, which resects the specimen through anus eversion by inserting the anvil extracorporeally while preserving the left colic artery, is safe and feasible for patients with low rectal cancer.
腹腔镜低位前切除术是治疗中低位直肠癌最常用的手术方法。本研究的目的是探讨在本研究中，在不做辅助切口经肛门取出标本的腹腔镜低位前切除术中，体外放置吻合器砧座并保留左结肠动脉的可行性和安全性。
收集2017年1月至2020年10月接受腹腔镜低位前切除术患者的临床资料和随访数据。对手术进行改良，在保留左结肠动脉的同时，体外放置抵钉座经肛门外翻切除标本，不使用辅助腹部切口。通过分析术后吻合口狭窄、吻合口出血和吻合口瘘的数据，阐明该手术方法对患者的优缺点。
共纳入22例患者。22例患者中有5例同时行双腔回肠造口术。术后排气时间为2 - 7天（中位数为3天）。术后1例发生吻合口出血，4例发生吻合口瘘，6例发生吻合口狭窄。4例患者术后发生远处转移，其中3例伴有局部复发。17例患者在随访期间无明显复发转移症状或体征，1例死于肝功能衰竭。
改良腹腔镜低位前切除术，即体外插入吻合器砧座经肛门外翻切除标本并保留左结肠动脉，对低位直肠癌患者是安全可行的。
