单孔腹腔镜直肠前切除术的临床应用

目的探讨常规腹腔镜器械在单孔腹腔镜直肠前切除术中的可行性和安全性。 方法采用常规腹腔镜器械,完成3例经脐单孔腹腔镜直肠前切除术。 结果3例患者平均手术时间155 min,术中出血量50～100 ml。随访2年,肿瘤无复发。结果 无一例中转开腹,手术时间平均(123±85) min,平均失血量为87 ml。下切缘为2～5 cm;术后平均住院时间为8 d ;吻合口漏1例,无盆腔感染、肠梗阻、腹腔及盆腔出血、吻合口出血及吻合口狭窄等并发症。 结论采用常规腹腔镜器械经脐行单孔腹腔镜直肠前切除术安全可行。     

腹腔镜下直肠低位前切除经肛门取标本手术八例

目的探讨腹腔镜下直肠低位前切除经肛门取标本手术的安全性和可行性。 方法采用回顾性描述性研究方法,收集2015年4月至2017年3月成都医学院第一附属医院胃肠外科开展的8例腹腔镜下直肠低位前切除经肛门取标本手术患者的临床和病理资料、随访情况。 结果患者平均年龄（66.9±11.7）岁,平均BMI（22.2±4.3）Kg/m²,手术平均用时（247.5±66.3）min,平均出血（22.5±3.8）ml;患者术后首次排气时间为（56.6±11.7）h,术后首次进流食时间为（36.6±7.6）h;TNM分期：Ⅰ期4例,Ⅱ期2例,Ⅲ期2例;一例患者术后出现吻合口漏,患者术后平均住院时间为（15.5±5.1）d;患者随访术后肛门功能正常,未见肿瘤复发和转移征象。 结论腹腔镜下直肠低位前切除经肛门取标本手术安全、可行。     

机器人结直肠癌根治术的初步应用体会

目的探讨达芬奇机器人手术系统应用于结直肠癌手术的初步体会。 方法回顾性收集吉林省肿瘤医院腹部肿瘤科2014年10月至2016年5月的63例结直肠癌行机器人手术患者临床数据,进行整理分析。 结果63例手术均顺利完成,无一例中转开腹,无术后并发症,机器人安装时间为（15.24±5.69）min,手术时间为（176.43±59.39）min,术中出血量（28.65±22.36）mL,清扫淋巴结数（14.47±5.67）枚,术后排气时间（51.43±12.96）h,术后住院日（8.22±1.52）d。 结论达芬奇机器人手术系统应用于结直肠癌的手术治疗安全可行,手术效果好,术后恢复快,适合临床应用。     

Early detection of anastomotic leaks after low anterior resection of the rectum

PURPOSE: Lysozyme destroys the mucopolysaccharide chains of the cell wall of gram-negative bacteria. It is a component of local defense and is formed in macrophages. Determination of lysozyme content in the wound seems to be the most reliable method for early recognition of wound infection. METHODS: In a prospective randomized study on the efficacy of single vs. double staple technique in anterior rectum resection, the effluent from the pelvic drain was examined with regard to its lysozyme activity. RESULTS: Lysozyme activity in drained secretion remained stable for more than 24 hours at room temperature. When the single staple technique was used, enzyme activity was sharply increased (mean, 9.6 mg/dl on the first postoperative day) compared with the double staple technique (mean, 5.5 mg/dl on the first postoperative day). The difference was statistically significant (P <0.0001). Mean lysozyme activity was increased in those patients with clinically (18 mg/dl on the first postoperative day) and radiologically (15.3 mg/dl on the first postoperative day) detected dehiscence (P < 0.0001). CONCLUSION: Lysozyme determination may be reproduced by detection of enzyme stability in drained secretion. Determination of lysozyme content seems to be a new possibility for early recognition of anastomotic dehiscence.Read at the Fourth European Congress of Surgery, Berlin, Germany, October 25 to 29, 1994.     

Side-to-end anastomosis in low anterior resection with the EEA stapler

A technical variant of the end-to-end colorectal anastomosis performed with the EEA stapler is described. It realizes a side-to-end anastomosis, performed via the oral-aboral route. In this manner, indications for stapled anastomoses can be extended to patients with discrepancy in bowel size, and where operative findings involve low anterior resection, with the patient not in the lithotomy—Trendelenburg position. The technique has been used with safety in 17 patients with colorectal and ileorectal anastomoses.     

Impact of transanal drainage tube on anastomotic leakage after laparoscopic low anterior resection

Background

Although a few reports have suggested transanal drainage tube (TDT) can reduce the pressure in the anastomotic portion, it remains unclear whether TDT can prevent anastomotic leakage (AL). In addition, little is known about the relationship between AL and daily fecal volume through TDT. This study investigated the role of TDT for the prevention of AL following laparoscopic low anterior resection (LAR).

Methods

This is a retrospective analysis of a prospectively maintained database of 201 rectal cancer patients who underwent laparoscopic LAR. The relationship between AL and daily fecal volume through TDT was examined.

Results

AL occurred in 25 patients. Based on the TDT grouping, AL occurred in 10.7% (19/178) of the TDT group, whereas it occurred in 26.1% (6/23) of the non-TDT group (P?=?0.046). In the 178 patients with TDT placement, the daily fecal volumes on postoperative days (PODs) 2–5 were significantly higher compared with those on POD 1 (P?<?0.05). The daily fecal volume was observed to be gradually increasing until POD 3 or 4 (median, 25 or 23 ml/day, respectively) and then significantly decreasing on POD 5 (10 ml/day) (P?<?0.05). The AL rate of the patients whose daily fecal volume exceeded 100 ml/day in two or more days was significantly higher than that of those in 0 or 1 day (26.9 vs. 7.9%; P?<?0.01).

Conclusions

TDT could be efficient to prevent AL following laparoscopic LAR. Postoperative fecal volume may be a reliable predictor of AL.

     

Machine learning model for prediction of low anterior resection syndrome following laparoscopic anterior resection of rectal cancer: A multicenter study

BACKGROUND Low anterior resection syndrome(LARS) severely impairs patient postoperative quality of life,especially major LARS. However,there are few tools that can accurately predict major LARS in clinical practice.AIM To develop a machine learning model using preoperative and intraoperative factors for predicting major LARS following laparoscopic surgery of rectal cancer in Chinese populations.METHODS Clinical data and follow-up information of patients who received laparoscopic anterior resecti...     

Early complications after low anterior resection for rectal cancer using the EEATM stapling device

Complications following 178 low anterior resections for rectal carcinoma with the EEA autosuture device are reported prospectively. The operative mortality was 2.8 percent. Clinical anastomotic leakage developed in 27 patients, but in none of the 30 patients over 76 years of age. Two of the five hospital deaths were related to leakage. Long-term steroid treatment and previous pelvic radiotherapy were associated with increased risk of leakage. Severe stenosis following anastomotic leakage was seen in one patient. Intraoperative diverting colostomy was done in 16 patients, but no benefit could be demonstrated. It was concluded that use of the upper sigmoid colon for anastomosis probably is not associated with a higher mortality and morbidity than that after more extensive resections reported in the literature. Future randomized trials should exclude very old patients, in whom no leak was seen, when the upper sigmoid colon was used for stapling after low anterior resection. Supported by The Danish Cancer Society     

限制性结肠脾曲游离技术在腹腔镜直肠癌低位前切除术中的临床应用

目的评价限制性脾曲游离（LSFM）技术在腹腔镜直肠癌低位前切除术中的应用效果和安全性。 方法回顾性总结分析2018年6月至2019年3月间广东省中医院收治的75例直肠癌患者临床病理资料,按照脾曲游离方法分为LSFM组（35例）和完全性脾曲游离（CSFM）组（40例）。 结果两组患者均能完成腹腔镜下的直肠-结肠的无张力吻合,未发生术中毗邻脏器的医源性损伤,手术标本质量分级（Nagtegaal分级）均为3级。两组患者的手术时间无显著性差异（176.8±55.7 vs 205.5±72.4 min,P>0.05）,但LSFM组的脾曲游离时间明显短于CSFM组（4.5±3.1 vs 25.4±9.3 min,P<0.01）。术中出血量、预防性造口比例、淋巴结清扫数目、术后首次肛门排气时间、术后住院时间、盆腔引流管引流量、引流管留置时间和术后并发症发生率两组间差异均无统计学意义（P>0.05）。两组均无术后30 d内再住院、再手术和死亡病例。 结论在腹腔镜直肠癌低位前切除术中行LSFM是安全可行的,与CSFM相比可以明显缩短手术时间,降低手术难度,并能取得同样满意的游离效果。     

Early experience in robot-assisted laparoscopic Heller myotomy

Heller myotomy for achalasia is routinely performed laparoscopically. This offers patients significant benefits compared to open surgery. Surgeons, however, are limited in their manipulation and visualization during laparoscopic interventions. Robotic telemanipulation systems were introduced with the objective of alleviating these limitations. The purpose of this study was to demonstrate the efficacy and safety of performing a Heller myotomy with the use of a robotic telemanipulation system. Fourteen patients were operated on with the da Vinci robot system. Robotic system set-up time, per- and postoperative complications, blood loss, operating time and hospital stay were recorded. Follow-up included manometry and symptom score. The robotic system set-up time was 15 min (10-15). Thirteen procedures (13/14: 93%) were completed by laparoscopic surgery. One procedure was converted because of inadequate exposure. One peroperative mucosal perforation was closed laparoscopically. The median blood loss was 10 mL (10-200). Median operating time was 90 min (75-150). Hospitalization ranged from 2 to 8 days (median 3). No complications occurred during a 30-day postoperative period. Dysphagia was relieved in 12/14 patients (86%). Heartburn was present postoperatively in 2/14 patients (14%). Manometry showed a significant decrease in median lower oesophageal sphincter (LOS) pressure from 2.9 preoperatively to 1 kPa postoperatively (P = 0.008). Robot-assisted laparoscopic Heller myotomy was demonstrated to be safe and effective in reducing basal LOS pressure and dysphagia. The results of this study clearly support the feasibility of the use of this system in performing a delicate laparoscopic surgical procedure. The use of a robotic system was experienced as being highly supportive in manipulation and visualization by the surgical team involved.     

Functional outcome following low anterior resection with total mesorectal excision in the elderly

BACKGROUND AND AIMS: Disturbance of bowel function is not uncommon following low anterior resection, but the effect of low anterior resection on the elderly has seldom been documented. This study investigated the functional outcome in elderly patients following low anterior resection for carcinoma of the rectum. PATIENTS AND METHODS: The study included 87 patients with carcinoma of middle and lower rectum who underwent curative low anterior resection with total mesorectal excision and remained alive without recurrence for at least 6 months following the resection or closure of stoma. Anorectal manometry and questionnaire survey of the patients' bowel function were performed during follow-up (median 24.1 months) to investigate the functional outcome after surgery. RESULTS: The median number of bowel motions was 2.5 per day in both elderly and young patients. Complete continence was achieved in 71.3% of patients, with both elderly and young patients performing similarly. The most common symptoms were clustering of bowel motions and urgency, which occurred in 30.3% and 34.9% of patients respectively, regardless of age. Manometric findings were also similar between the elderly and their younger counterparts. CONCLUSION: Bowel function and manometric findings following low anterior resection with total mesorectal excision in the elderly are not worse than in younger patients.