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首页> 外文期刊>Surgical endoscopy >Transanal hybrid colon resection: techniques and outcomes for benign colorectal diseases
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Transanal hybrid colon resection: techniques and outcomes for benign colorectal diseases

机译：经肛门混合结肠切除术：良性结直肠疾病的技术和结果

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Background Transanal hybrid rectal and colon resection have been introduced in recent years at dedicated surgical centers. The anus is used as a natural orifice for large size access. The use of transanal hybrid colectomy techniques is still in its infancy with outcomes and unique complications being identified. The purpose of this work is the evaluation of outcomes for transanal hybrid colon resections (ta-CR), including intra operative and postoperative complications, results, and advantages. Methods A prospectively maintained database was analyzed. Inclusion criteria were any patient who underwent ta-CR for rectal prolapse, slow transit, obstructive defaecation, and chronic sigmoid diverticulitis. Patients were excluded from ta-CR if BMI > 30, major previous abdominal surgery, or presence of a large inflammatory mass in diverticulitis. Transanal access was used for all operative steps requiring access of more than 5 mm, such as staplers, large graspers, and specimen retrieval. Data acquisition and analysis was performed for operative time, complications, and postoperative quality of life. Results From 2012 to 2017, 82 patients underwent ta-CR 33 males, 49 females, median age 58 (24-80). Transanal-subtotal colectomy and ta-CR for constipation was performed in 12 patients; ta-CR and rectopexy in 31, and ta-CR for diverticulitis was performed in 39 patients. Conversion to traditional approach was required in 3 cases (3.6). Intraoperative complication included 1 rectal tear requiring intervention. Post-op complications included 3 leaks requiring laparoscopic and 1 open revision, the latter developed wound infection and an incisional hernia. Gastrointestinal Quality of Life Index (GIQLI) improved significantly from preoperative 89 to postoperative 119 (p < 0.001). No patients with ta-CR without open revision developed a hernia post-op with median 18 months follow-up. Conclusions ta-CR is a safe and effective NOTES Hybrid technique for colorectal procedures in selected patients with benign colon disorders. GIQLI shows improvement and this technique can have the potential in preventing wound and hernia complications.
机译：背景 近年来，经肛门混合直肠和结肠切除术已在专门的外科中心引入。肛门被用作大尺寸通路的天然孔口。经肛门混合结肠切除术的使用仍处于起步阶段，结果和独特的并发症正在确定中。这项工作的目的是评估经肛门混合结肠切除术 （ta-CR） 的结果，包括术中和术后并发症、结果和优势。方法 分析前瞻性维护的数据库。纳入标准是任何因直肠脱垂、慢转运、梗阻性排便和慢性乙状结肠憩室炎而接受 ta-CR 的患者。如果 BMI > 30、既往接受过腹部大手术或憩室炎中存在较大的炎症肿块，则患者被排除在 ta-CR 之外。经肛门通路用于所有需要超过 5 mm 通路的手术步骤，例如吻合器、大抓取器和标本取出。对手术时间、并发症和术后生活质量进行数据采集和分析。结果 2012—2017年，82例患者行ta-CR行术[男性33例，女性49例，中位年龄58岁（24-80岁）]。12例患者行经肛门次全结肠切除术和ta-CR治疗便秘;31 例患者行 ta-CR 和直肠固定术，39 例患者行 ta-CR 治疗憩室炎。3例（3.6%）需要转为传统方法。术中并发症包括 1 例需要干预的直肠撕裂。术后并发症包括 3 例需要腹腔镜的渗漏和 1 例开放翻修，后者出现伤口感染和切口疝。胃肠道生活质量指数 （GIQLI） 从术前 89 显着改善到术后 119 （p < 0.001）。没有未开放翻修的 ta-CR 患者在术后发生疝气，中位随访时间为 18 个月。结论 ta-CR是一种安全有效的NOTES混合技术，用于部分结肠良性结肠疾病患者的结直肠手术。GIQLI 显示出改善，该技术有可能预防伤口和疝气并发症。

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