Bergamaschi R, Haugstvedt T K, Marvik R
Institute of Surgery, Diakonissehjemmets University Hospital, Bergen, Norway.
JSLS. 1998 Jan-Mar;2(1):47-9.
An experimental study was undertaken to evaluate whether a previously described technique for laparoscopic sigmoid resection with intracorporeal resection-anastomosis and specimen removal via a suprapubic incision could be facilitated and applied to the rectum.
Ten domestic pigs (median weight 41 kg) underwent low anterior resection of the rectum, which was transected with an articulating endoscopic stapler. Pursestring sutures were fashioned intracorporeally with a laparoscopic pursestring clamp. The anvil of a circular stapler was inserted through a 33 mm port into the colon and pursestring tied intracorporeally. A circular gun with a spike fixed to its shaft was introduced per anum and a double-stapled anastomosis performed.
Complete doughnuts were obtained in all cases and anastomoses were all methylene blue tight. All porcine subjects had an uneventful 5-week postoperative course. The median anastomotic level from the anal verge was 5.2 cm. Histology of colorectal anastomoses revealed healing mucosa.
The use of articulating endoscopic stapler, laparoscopic pursestring clamp, and circular stapler with a spike fixed to its shaft seems to facilitate a previously described intracorporeal approach to sigmoid resection which was safely applied to the rectum in a porcine model.
开展一项实验研究，以评估一种先前描述的腹腔镜乙状结肠切除术技术（体内切除吻合，经耻骨上切口取出标本）是否能够简化并应用于直肠手术。
10头家猪（平均体重41千克）接受直肠低位前切除术，使用关节式内镜吻合器横断直肠。用腹腔镜荷包钳在体内制作荷包缝线。将圆形吻合器的钉砧通过一个33毫米的端口插入结肠，并在体内系紧荷包缝线。将带有固定在轴上的尖刺的圆形吻合器经肛门插入，进行双吻合器吻合。
所有病例均获得完整的切除标本环，吻合口均用亚甲蓝检测无渗漏。所有猪的术后5周病程均顺利。吻合口距肛缘的中位距离为5.2厘米。结直肠吻合口的组织学检查显示黏膜愈合。
使用关节式内镜吻合器、腹腔镜荷包钳以及带有固定在轴上尖刺的圆形吻合器，似乎能够简化先前描述的乙状结肠切除体内入路，该方法在猪模型中安全地应用于直肠手术。
