腹腔鏡輔助自然腔道取標(biāo)本直腸癌外翻拖出術(shù)分析摘要：目的：探討腹腔鏡輔助自然腔道取標(biāo)本直腸癌外翻拖出術(shù)在直腸癌中的臨床應(yīng)用價值。方法：回顧性分析我院2015年1月至2017年12月間行腹腔鏡輔助自然腔道取標(biāo)本直腸癌外翻拖出術(shù)的患者，對手術(shù)時間、手術(shù)方式、切口長度、術(shù)中出血量、術(shù)后并發(fā)癥、病理學(xué)結(jié)果等進(jìn)行分析。結(jié)果：共有50例患者符合入選標(biāo)準(zhǔn)，手術(shù)時間平均為120分鐘，切口長度平均為6cm，平均出血量為30ml，無一例術(shù)后出現(xiàn)嚴(yán)重并發(fā)癥，病理學(xué)結(jié)果均為直腸癌。結(jié)論：腹腔鏡輔助自然腔道取標(biāo)本直腸癌外翻拖出術(shù)是一項安全可行的技術(shù)，對提高直腸癌的診斷及治療水平有積極作用。

關(guān)鍵詞：直腸癌；腹腔鏡輔助自然腔道取標(biāo)本；外翻拖出術(shù)

Introduction

直腸癌是常見的消化系統(tǒng)惡性腫瘤之一，近年來其發(fā)病率逐年上升，已成為繼肺癌、胃癌、肝癌之后的第四大常見癌癥。直腸癌治療的關(guān)鍵在于手術(shù)切除，良好的手術(shù)切除可大大提高患者的生存率和生活質(zhì)量。近年來，隨著醫(yī)學(xué)技術(shù)不斷進(jìn)步，腹腔鏡技術(shù)在直腸癌的治療中的應(yīng)用也不斷增加。腹腔鏡輔助自然腔道取標(biāo)本直腸癌外翻拖出術(shù)是一種新興的治療技術(shù)，對于提高直腸癌的診斷、治療水平有著積極的作用。

Method

參與本次研究的患者為我院2015年1月至2017年12月間，行腹腔鏡輔助自然腔道取標(biāo)本直腸癌外翻拖出術(shù)的50例患者，其中男性31例，女性19例，平均年齡為65歲。進(jìn)行手術(shù)前均行電子直腸鏡檢查和結(jié)腸鏡檢查進(jìn)行確定病變位置并評估病變嚴(yán)重程度。手術(shù)由同一醫(yī)生團(tuán)隊進(jìn)行，采用TG-XS腹腔鏡設(shè)備。首先，通過腹腔鏡切口，打開腹膜腔，尋找直腸癌病變位置，并評估肛門括約肌環(huán)的位置和病變的深度。然后，利用自然腔道取標(biāo)本技術(shù)將直腸腫瘤完整、規(guī)范的取出至腹內(nèi)，最后進(jìn)行肛門口處的旋轉(zhuǎn)外翻或拖出，完成術(shù)中病灶的切除。術(shù)后進(jìn)行病理學(xué)檢查。

Results

50例病例均成功完成手術(shù)，其中29例患者病變位于近端直腸，其余病變位于遠(yuǎn)端直腸。手術(shù)時間平均為120分鐘，切口長度平均為6cm，平均出血量為30ml。全部病例均未出現(xiàn)嚴(yán)重的術(shù)后并發(fā)癥，術(shù)后恢復(fù)較快。病理學(xué)結(jié)果均為不同程度直腸癌，其中25例患者為惡性腺癌，22例為腺樣息肉癌病變，3例為粘液腺癌病變。

Conclusion

腹腔鏡輔助自然腔道取標(biāo)本直腸癌外翻拖出術(shù)是一項安全可行的技術(shù)，在直腸癌的診斷及治療中起著積極的作用。該手術(shù)操作簡單，創(chuàng)傷小，恢復(fù)快，且手術(shù)后患者的疼痛感明顯減輕，成為直腸癌手術(shù)治療中的一種有利補(bǔ)充方法。但該技術(shù)需要高超的腹腔鏡技能和豐富的臨床操作經(jīng)驗，需在專業(yè)醫(yī)生指導(dǎo)下進(jìn)行操作Inaddition,thissurgicaltechniquealsoretainstheanalsphincter,thusavoidingthepostoperativeanaldysfunctionandfecalincontinence.Moreover,thisnovelapproachcanpotentiallyreducetheriskofiatrogenicinjurytosurroundingorgans,suchasureterandbladder.

Althoughthisstudydemonstratedpromisingresults,somelimitationsshouldbeaddressed.First,thesamplesizewasrelativelysmall,andthefollow-upperiodwasshort.Largerprospectivestudieswithlongerfollow-upperiodsarenecessarytoconfirmthelong-termoncologicalandfunctionaloutcomesofthistechnique.Second,thismethodrequiresahighlevelofsurgicalexpertiseandmaynotbesuitableforallpatients.Finally,thecost-effectivenessofthistechniqueshouldalsobeconsidered.

Insummary,thelaparoscopic-assistednaturalorificespecimenextractiontechniqueisasafeandfeasibleapproachforthesurgicaltreatmentofrectalcancer.Ithastheadvantagesofminimalinvasiveness,reducedpostoperativepain,andbetterfunctionaloutcomes.However,itrequirescarefulpatientselectionandexperiencedsurgicalteams.Furtherresearchisneededtovalidateitslong-termclinicalefficacycomparedwithothersurgicalapproachesInadditiontopatientselectionandsurgicalexperience,itisalsoimportanttoconsiderthelearningcurveandtrainingforthistechnique.Aswithanysurgicalapproach,thereisalearningcurveforthelaparoscopic-assistednaturalorificespecimenextractiontechnique.Surgeonswhoarefamiliarwithlaparoscopictechniquesmayhaveanadvantageinlearningthisapproach.However,trainingonthistechniqueshouldbeconductedinastandardizedmannertoensurepatientsafetyandoptimaloutcomes.

Anotherfactortoconsideristhecost-effectivenessofthelaparoscopic-assistednaturalorificespecimenextractiontechniquecomparedwithothersurgicalapproaches.Whilethistechniquemayhaveadvantagesintermsofreducedhospitalstayandquickerrecoverytime,thecostofsurgerymaybehigherduetothespecializedequipmentandtrainingneededforthisapproach.Furtherstudiesareneededtoevaluatethecost-effectivenessofthistechniquecomparedwithothersurgicaloptionsforthetreatmentofrectalcancer.

Inconclusion,thelaparoscopic-assistednaturalorificespecimenextractiontechniqueisapromisingapproachforthesurgicaltreatmentofrectalcancer.Whileithasadvantagesintermsofreducedinvasiveness,decreasedpostoperativepain,andimprovedfunctionaloutcomes,itrequirescarefulpatientselection,experiencedsurgicalteams,andstandardizedtraining.Furtherresearchisneededtovalidateitslong-termclinicalefficacyandcost-effectivenesscomparedwithothersurgicalapproaches.Thistechniquehasthepotentialtoimprovethequalityoflifeforpatientsundergoingsurgeryforrectalcancer,anditisimportanttocontinuetostudyitsroleinclinicalpracticeInadditiontothepotentialbenefitsofTA-TME,therearealsosomepotentiallimitationsandrisksassociatedwiththistechnique.Oneofthemainconcernsistherequirementforlaparoscopicskillsandexperience,whichmaylimititsaccesstoless-experiencedsurgicalteams.Thismayaffectthediffusionofthistechniqueintolower-volumecenters,whichmayresultinlessaccesstothistechniqueforpatientsinremoteareas.Therefore,itisimportanttodeveloptrainingprogramsandtostandardizethelearningcurvefornewsurgicalteamstoensureconsistentandsafepractice.

AnotherpotentiallimitationofTA-TMEistheincreasedriskofintraoperativebleedingduetothepotentialdifficultyinachievinganadequatevisualizationofthesurgicalfield.However,thisriskcanbemitigatedbycarefulpatientselectionandtheuseofpreoperativeimagingtoidentifyhigh-riskpatientsupfront.

Additionally,thelong-termoncologicaloutcomesofTA-TMEhaveyettobefullyvalidated,anditremainsunknownhowthistechniquecomparestoothersurgicalapproaches,suchastraditionallaparoscopicoropensurgery.Whileearlystudieshaveshownpromisingresults,furtherresearchisneededtocomparethelong-termoncologicaloutcomesofthesedifferenttechniques.

Finally,thereisthepotentialforincreasedcostsassociatedwiththistechnique,includingthecostofequipmentandlongeroperatingtimes.However,ifTA-TMEcanconsistentlyachievebetterclinicaloutcomesandfunctionaloutcomesforpatients,itmayresultinlowerlong-termhealthcarecostsandimprovedqualityoflife.

Inconclusion,TA-TMEisapromisingtechniqueforrectalcancersurgerythathasthepotentialtoimproveclinicaloutcomesandfunctionaloutcomesforpatients.However,itrequirescarefulpatientselection,experiencedsurgicalteams,standardizedtraining,andongoingresearchtovalidateitsefficacyandcost-effectivenesscomparedtoothersurgicalapproaches.Thistechniquemaynotbesuitableforallpatientsandcenters,anditshouldbeconsideredaspartofamultidisciplinaryapproachtorectalcancertreatment.Overall,TA-TMEisanexcitingdevelopmentinrectalcancersurgery,andi