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首页> 外文期刊>Surgical Endoscopy >Laparoscopic total mesorectal excision for low rectal cancer.
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Laparoscopic total mesorectal excision for low rectal cancer.

机译：腹腔镜全直肠系膜切除术治疗低位直肠癌。

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BACKGROUND: Laparoscopic total mesorectal excision for rectal cancer is coming out of age with recent publications highlighting its safety, feasibility, sound oncological outcomes, and improved quality of life. Nevertheless, laparoscopic proctectomy remains a challenging procedure. An embedded didactic video demonstrates a step-by-step laparoscopic total mesorectal excision with coloanal anastomosis for a low rectal cancer. METHODS: A five-trocar technique is shown. The key steps demonstrated are: high division of the inferior mesenteric artery, medial-to-lateral mobilization of the descending colon, high division of the inferior mesenteric vein, take-down of the splenic flexure, total mesorectal excision with division of the rectum at the pelvic floor, and side-to-end coloanal anastomosis. Principles of a good anastomosis and potential pitfalls are described, including protection of the ureter and pelvic autonomic nerves. RESULTS: A series of ten consecutive patients operated for low rectal cancer with total mesorectal excision is reported. Median (range) operative time and estimated blood loss were 274 (135-360) minutes and 25 (10-50) ml. Median tumor height from the anal verge was 7 (4-10) cm. Reconstruction included three coloanal J-pouch and seven side-to-end anastomosis. Nine anastomoses were performed by using a double-stapled technique. One patient with an intersphincteric dissection required a handsewn anastomosis. A diverting ileostomy protected all coloanal anastomosis. Median length of stay was 3 (range, 2-7) days. One of ten patients was readmitted for a small bowel obstruction. The embedded video demonstrates a total mesorectal excision down to the pelvic floor in a patient who had a T2 cancer 6 cm from the anal verge with prior open cholecystectomy and hysterectomy. CONCLUSIONS: Laparoscopic total mesorectal excision is a safe and effective procedure. Patient selection and advanced laparoscopic skills are paramount. It is hoped that this didactic video will contribute to a wider and safer practice of laparoscopic total mesorectal excision for low rectal cancer.
机译：背景：腹腔镜直肠癌全肠系膜切除术已经过时，最近的出版物强调其安全性，可行性，良好的肿瘤学结局和改善的生活质量。然而，腹腔镜直肠切除术仍然是具有挑战性的过程。嵌入式教学视频演示了针对低位直肠癌的腹腔镜全直肠系膜全直肠切除术以及结肠吻合术。方法：显示了一种五套管针技术。所展示的关键步骤包括：肠系膜下动脉高度分割，降结肠的内侧到外侧动员，肠系膜下静脉高度分割，脾曲张切除，直肠全切及直肠系膜切除盆底和端到端结肠吻合术。描述了良好吻合和潜在隐患的原理，包括保护输尿管和盆腔自主神经。结果：报道了一系列连续十例接受低位直肠癌全直肠系膜切除术的患者。中位（范围）手术时间和估计失血量为274（135-360）分钟和25（10-50）ml。距肛门边缘的肿瘤中位高度为7（4-10）cm。重建包括三个结肠J型袋和七个端对端吻合术。通过使用双吻合钉技术进行了九个吻合术。一位有括约肌夹层的患者需要手缝吻合术。分流回肠造口术可保护所有结肠吻合术。中位住院时间为3天（范围2-7）。十名患者中的一名因肠梗阻而再次入院。嵌入的视频演示了一名患有T2癌且距肛门边缘6厘米的患者，此前曾进行了开腹胆囊切除术和子宫切除术，直至直肠骨底全部切除了直肠。结论：腹腔镜全直肠系膜切除术是一种安全有效的方法。患者选择和先进的腹腔镜检查技巧至关重要。希望这段教学视频能为腹腔镜低位直肠癌全肠系膜全直肠切除术的发展提供更广泛，更安全的实践。

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