摘要
目的:探讨腹腔镜全直肠系膜切除术(total mesorectal excision,TME)的无瘤技术。方法:基于肿瘤根治性切除的概念、TME的原则及开腹手术的无瘤操作常规,评价腹腔镜TME手术全过程,总结应遵循的无瘤技术常规。结果:腹腔镜TME的无瘤技术包括:(1)防止穿刺孔漏气;(2)尽早吸尽腹水;(3)封闭浆膜面;(4)绑扎肠管;(5)优先处理肠系膜下血管并高位结扎;(6)沿正确平面锐性解剖;(7)非触碰技术;(8)充分游离直肠末段;(9)先冲洗肛管直肠后横断直肠;(10)保护标本取出口;(11)盆腔冲洗;(12)经套管释放气体。结论:腹腔镜TME同样应坚守肿瘤学原则,采用严格的无瘤操作技术,以保证肿瘤学的安全性。腹腔镜TME无瘤技术除与开腹TME原则相符外,还特别强调防止气腹"烟囱效应"和标本取出口的保护。
Objective：To study the non-tumor technique of laparoscopic total mesorectal excision（TME） for rectal cancer.Methods：Based on the modern concept of radical resection for cancer,the principles of TME and the routine non-tumor techniques of conventional laparotomy,the operative steps of 93 cases of laparoscopic TME for middle-lower rectal cancer were evaluated and the non-tumor skills were concluded.Results：The non-tumor techniques of laparoscopic TME were as follows：（1） prevent the gas leakage,（2） suck the peritoneal fluid as early as possible,（3） spray fibrin glue on the surface of serosa surface invaded by cancer,（4） band the proximal rectum,（5） high ligation of the inferior mesenteric artery and vein at their origin,（6） sharp dissection in the right plane,（7） no touch technique,（8） adequate mobilization of the distal rectum,（9） wash the anorectum before transection of rectum,（10） wound protection,（11） wash the pelvic cavity,（12） delete the CO2 gas through the port.Conclusions：Laparoscopic TME should follow the principles of oncology and open TME strictly.To guarantee the oncological safety,a criteria of completely and strictly non-tumor techniques is recommended.The presented techniques are consistent with the principles of the open TME,and more emphasis should be put on the skills of prevention against chimney effect and wound protection.
出处
《腹腔镜外科杂志》
2010年第6期413-416,共4页
Journal of Laparoscopic Surgery
基金
广东省科技计划项目(编号:2006B12901006)
广州市科技攻关项目(编号:2006Z3-E0571)
