基于一种螺纹扩肛器的超低位直肠癌精准保肛（PPS）手术

目的探究自制新型透明螺纹扩肛器应用于自然腔道取标本手术（NOSES）治疗超低位直肠癌的安全性及优势。 方法回顾性分析2018年5月~2018年6月上海市第十人民医院胃肠外科采用自制螺纹扩肛器完成腹腔镜联合经肛手工吻合超低位直肠癌精准保肛（PPS）NOSES手术5例患者的临床资料，总结患者的手术时间、术中出血量、术后住院时间、并发症、肛门功能情况等相关指标。 结果5例患者顺均利完成超低位直肠癌PPS术，平均手术时间为（217.01±37.75）min，平均术中出血量为（108.32±53.15）mL，平均术后住院时间为（6.34±1.72）天，术后肛门功能Wexner、Vaizey平均评分均为3分，术后均无显著并发症发生。 结论应用新型螺纹扩肛器完成PPS手术治疗超低位直肠癌安全有效，避免了腹部辅助切口、显著减少了手术创伤，同时可在直视下精准地切除病灶，极大限度地保存及改善了患者术后的肛门功能，提高了术后生活质量，可操作性强且经济实用，值得在临床上推广应用，但上述结论仍需大样本临床研究进一步验证。

Precision functional sphincter-preserving surgery (PPS) for low rectal cancer using screw-thread anal dilator

ObjectiveTo explore the safety and advantages of using our new self-made transparent screw-thread anal dilator in the treatment of ultra-low rectal cancer through natural orifice specimen extraction surgery (NOSES). MethodsRetrospective analysis of 5 cases in which patients underwent the laparoscopy combined with transanal manual anastomosis precision functional sphincter-preserving NOSES surgery (PPS) for Ultra-Low Rectal Cancer using the new screw-thread anal dilator between May 2018 to June 2018 at Gastrointestinal Surgery Department, Shanghai Tenth People's Hospital. A summary was made of the patients' operation time, intraoperative bleeding volume, length of hospital stay, complications and anal function. ResultsThe PPS for Ultra-Low Rectal Cancer was successfully completed in all 5 patients. The average operation time was (217.01±37.75) min, the average intraoperative bleeding volume was (108.32±53.15) mL, the average length of hospital stay after operation was (6.34±1.72) days, average Wexner and Vaizey scores for anal function after operation were 3 points, and no significant complications occurred after operation. ConclusionUsing the new screw-thread anal dilator in the treatment of ultra-low rectal cancer through PPS has proven to be safe and effective. Incision of abdomen to extract specimen was avoided, and the surgical trauma was significantly reduced. At the same time, the lesion can be precisely resected under direct vision, with post-operative anal function being preserved and improved to a great extent, thus improving quality of life after operation. Moreover, the device is operable, economical and practical; indeed, it is worth promoting and applying in clinic. However, the above conclusions still need to be further validated by clinical studies with large sample sizes.