【摘要】 单人三孔行腹腔镜下乙状结肠癌根治术(经自然腔道取标本手术)安全可行,创伤小。笔者团队前期已经开展此类手术并取得较好的效果,也探讨了端端吻合及侧侧吻合的不同手术技巧。然而,针对左半结肠癌,由于缺少助手的协助,要完成单人三孔操作下的完全腹腔镜下吻合会受到很多的限制,比如大网膜的抓持张力、左半结肠系膜的提吊、Toldt间隙的显露、脾曲的游离与暴露等。如果解剖层次出错,会造成出血等并发症;并且在吻合过程中,无助手帮助下进行侧侧吻合,肠管会出现移动,容易造成吻合困难甚至失败,引起吻合口漏等严重并发症。虽然笔者团队前期采取体外丝线固定方法,但在左半结肠癌手术中的应用效果不佳。综上,笔者团队在前期基础上提出一种创新的手术技巧:采用移动悬吊技术解决张力及暴露问题,采用左侧腹壁缝合固定方法解决侧侧吻合过程中的肠管摆动现象,并最终经自然腔道取出标本。本改良术式围手术期的效果良好,远期肿瘤学疗效尚需观察。更多还原

【Abstract】 Laparoscopic radical resection of sigmoid colon cancer through natural orifice specimen extraction surgery(NOSES) with single-surgeon and three-port is safe,feasible,and minimally invasive clinical technology.The authors’ team have already reported this type of surgery successfully before and also discussed different experience for end-to-end anastomosis and side-to-side anastomosis.For left colon cancer,complete laparoscopic anastomosis with single-surgeon and three-port is difficult due to the lack of additional help,such as grasping tension of the greater omentum,lifting of the left mesentery,exposure of the Toldt’s space,and dissociation and exposure of splenic flexure.Deviation from anatomical layers will lead to complications such as bleeding.Besides,during the side-to-side anastomosis process,no assistance to restrict the intestinal tract may cause difficulty or even failure in anastomosis,leading to serious complications such as anastomotic leakage.Although extracorporeal wire was used for fixation before,this method was not effective for the left colon.Based on our preliminary experience,the authors’ team propose an innovative surgical technique:the mobile suspension method to address tension and exposure challenges,combined with left abdominal wall suture fixation to eliminate bowel displacement during side-to-side anastomosis.Specimens were successfully extracted via the natural orifice.This modified approach demonstrated favorable perioperative outcomes,though its long-term oncological efficacy warrants further investigation.更多还原