Rea R, Ruggiero R, Boccia G, Varletta G, Saccone C, Laprovitera A, Ferrara A, Procaccini E
Istituto di Chirurgia Sperimentale, II Università degli Studi di Napoli.
Ann Ital Chir. 1996 May-Jun;67(3):425-33; discussion 433-4.
Nowadays oncologic surgery is defining new criteria in the treatment of rectal cancer: preservation of sfincterial function, ultra-low resections with distal margin at only 2 cm distally to the tumor, role of mesorectum as preferential site of lymphatic diffusion, preservation of lombo-aortic and pelvic nerves. Laparoscopy is showing good results in bowel surgery so as previously got on biliary tract: less visceral manipulation, less stimulation of immunologic system, less pain, early resumption of peristalsis and food intake, better recovery, less hospital stay. We experimented on pig ultra-low laparoscopic resection of the rectum, with preservation of sfincterial function, and mechanical anastomosis at the upper edge of the sfincterial ring. The evaluation of surgical technique, post-operative supervision, and follow-up instrumental control (anal manometry, endo-rectal ultrasonography, sfincterial electtromanometry, Rx barium enema) show technical feasibility and confirm a better recovery with regular defecatory function.
如今，肿瘤外科手术正在为直肠癌的治疗定义新的标准：保留括约肌功能、进行远端切缘仅距肿瘤2厘米的超低位切除、直肠系膜作为淋巴扩散的优先部位的作用、保留腰主动脉和盆腔神经。腹腔镜检查在肠道手术中显示出良好的效果，就像之前在胆道手术中一样：更少的内脏操作、对免疫系统的刺激更少、疼痛更少、肠蠕动和食物摄入恢复更早、恢复更好、住院时间更短。我们对猪进行了腹腔镜超低位直肠切除术，保留了括约肌功能，并在括约肌环上缘进行了机械吻合。对外科技术、术后监测和随访仪器控制（肛门测压、直肠内超声检查、括约肌肌电图、钡剂灌肠X线检查）的评估显示了技术可行性，并证实排便功能正常时恢复更好。
