Decanini C, Milsom J W, Böhm B, Fazio V W
Department of Surgery, Hospital Central Militar, Mexico City, Mexico.
Dis Colon Rectum. 1994 Jun;37(6):552-8. doi: 10.1007/BF02050989.
Although the use of laparoscopic techniques in colorectal surgery has recently become a focus of major interest in intestinal surgery, there is no proof that an oncologic abdominoperineal resection can be accomplished using laparoscopic techniques. The hypothesis of this study is that a standardized technique for laparoscopic oncologic abdominoperineal resection according to accepted oncologic surgical principles can be developed in a cadaver model. The end points of this study were intraoperative complications, success in performance of proximal vascular ligation of the inferior mesenteric artery, complete removal of the mesorectum including all lymph nodes adjacent to the named rectal arteries, and wide clearance of pelvic side walls.
Laparoscopic abdominoperineal resection was performed in 11 fresh cadavers (1 female and 10 males). After surgery, all cadavers underwent autopsy. The number of removed and remaining mesenteric lymph nodes, length of remaining inferior mesenteric artery, and mesorectal and the pelvic side wall soft tissue were evaluated.
No major intraoperative complications were recorded. The median number of removed lymph nodes in the mesorectum was 12 (range, 6-22) and no remaining lymph nodes were found at the base of the inferior mesenteric artery. The median length of remaining inferior mesenteric artery was 5 (range, 1-15) mm. Wide lateral clearance of pelvic side walls was noted in all patients.
A laparoscopic technique of abdominoperineal resection can be performed according to oncologic principles with proximal vascular ligation of inferior mesenteric artery, wide clearance of pelvic side walls, and complete removal of mesorectum using our described technique.
尽管腹腔镜技术在结直肠手术中的应用近来已成为肠道手术主要关注的焦点，但尚无证据表明可以使用腹腔镜技术完成肿瘤性腹会阴联合切除术。本研究的假设是，在尸体模型中可以开发出一种根据公认的肿瘤外科原则进行腹腔镜肿瘤性腹会阴联合切除术的标准化技术。本研究的终点是术中并发症、肠系膜下动脉近端血管结扎的操作成功、包括与命名直肠动脉相邻的所有淋巴结在内的直肠系膜的完全切除以及盆腔侧壁的广泛清扫。
对11具新鲜尸体（1例女性和10例男性）进行腹腔镜腹会阴联合切除术。术后，所有尸体均接受尸检。评估切除和剩余的肠系膜淋巴结数量、剩余肠系膜下动脉的长度以及直肠系膜和盆腔侧壁软组织情况。
未记录到重大术中并发症。直肠系膜切除的淋巴结中位数为12个（范围6 - 22个），在肠系膜下动脉根部未发现残留淋巴结。剩余肠系膜下动脉的中位数长度为5毫米（范围1 - 15毫米）。所有患者均实现了盆腔侧壁的广泛外侧清扫。
使用我们所描述的技术，可以按照肿瘤学原则进行腹腔镜腹会阴联合切除术，包括肠系膜下动脉近端血管结扎、盆腔侧壁的广泛清扫以及直肠系膜的完全切除。
