Totally Laparoscopic Sigmoidectomy with Transrectal Specimen Extraction

全腹腔鏡乙狀結腸切除術並經由直腸取出樣本

陳映哲(Ying-Che Chen) ； 盧文益(Wen Yi Lu) ； 黃超俊(Chao-Chun Huang) ； 謝建勳(Jan-Sing Hsieh)

《中華民國大腸直腸外科醫學會雜誌》 27卷4期 (2016/12) Pp. 162-168

https://doi.org/10.6312/SCRSTW.2016.27(4).10513

摘要

目的 全腹腔鏡大腸切除並經由自然孔道取出樣本的手術已有文獻報導且也獲得越多人感興趣。我們以全腹腔鏡乙狀結腸切除術並經由自然孔道取出樣本，治療乙狀結腸癌的患者，並進一步探討其結果。方法 我們收集乙狀結腸癌的患者，紀錄其手術前的資料、腫瘤的大小和肛門邊緣的距離，且對手術後的結果進行分析。這些患者皆接受全腹腔鏡大腸切除、腹內結腸直腸吻合術且經由自然孔道取出樣本。結果 我們進行腹腔鏡切除及腹內結腸直腸吻合術，成功地治療33例乙狀結腸癌。平均手術時間為191±28分鐘，平均出血量為53±18毫升。所有的患者皆出現輕度術後疼痛，但在術後三天可回復腸道功能。他們的平均住院天數為6天。所有患者皆未發生重大手術併發症或吻合口瀉漏的情況。標本中病灶的平均大小為3.6±1.0厘米，淋巴結獲取的平均數為13±6。所有病人在術後的追蹤期間，並未發現有因體內吻合或經直腸標本取出術造成的肛門功能障礙。結論 全腹腔鏡大腸切除術治療乙狀結腸癌是安全且有效的方式。

關鍵字

全腹腔鏡大腸切除術 ； 經直腸樣本取出 ； 體內結腸直腸吻合術 ； 乙狀結腸癌

並列摘要

Background. Totally laparoscopic colectomy with natural orifice specimen extraction (NOSE) has been reported with great interest. We attempt to evaluate the feasibility of this technique for totally laparoscopic sigmoidectomy with NOSE and report immediate postoperative outcomes in patients with sigmoid colon cancer. Methods. Patients with sigmoid cancer were selected depending on the size of the tumor and its distance from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed. After complete resection of the tumor, all patients underwent an intracorporeal colorectal anastomosis following transrectal specimen extraction. Results. Laparoscopic resection with our technique of intracorporeal anastomosis was successful in 33 patients. The average operative time was 191 ± 28 min and mean blood loss was 53 ± 18 cc. All patients experienced mild postoperative pain and the bowel function returned before POD 3 in most patients. They had an uneventful postoperative course with a median hospital stay of 6 days. Major perioperative complications or anastomotic leak were not encountered in this study. The mean size of the lesion was 3.6 ± 1.0 cm and the mean number of harvested nodes was 13 ± 6. During the follow-up period, there were no functional disorders associated with the intracorporeal anastomosis or transrectal specimen extraction. Conclusion. Totally laparoscopic colorectal surgery is a safe and effective procedure for patients with sigmoid colon malignancy.

並列關鍵字

Totally laparoscopic colectomy ； Transrectal specimen extraction ； Intracorporeal colorectal anastomosis ； Sigmoid colon cancer

參考文獻

1. Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg 2009;22(4):191-7.

2. Lorenzon L, Pilozzi E, La Torre M, Ziparo V, Ferri M. Impact and prognostic implications of colon cancers stage II sub-classification through the years. Int J Colorectal Dis 2012;27(10):1311-8.

3. La Torre M, Lorenzon L, Pilozzi E, Barucca V, Cavallini M, Ziparo V, et al. Number of harvested lymph nodes is the main prognostic factor in Stage IIa colorectal cancer patients. J Surg Oncol 2012;106(4):469-74.

4. Dias AR, Nahas CS, Marques CF, Nahas SC, Cecconello I. Transanal endoscopic microsurgery: indications, results and controversies. Tech Coloproctol 2009;13(2):105-11.

5. Madbouly KM, Remzi FH, Erkek BA, Senagore AJ, Baeslach CM, Khandwala F, et al. Recurrence after transanal excision of T1 rectal cancer: should we be concerned? Dis Colon Rectum 2005;48(4):711-21.