Laparoscopic local excision and rectoanal anastomosis for rectal gastrointestinal stromal tumor: modified laparoscopic intersphincteric resection technique
Laparoscopic local excision and rectoanal anastomosis for rectal gastrointestinal stromal tumor: modified laparoscopic intersphincteric resection technique
复制标题
腹腔镜局部切除直肠吻合术治疗直肠胃肠道间质瘤：改良腹腔镜括约肌间切除技术
DOI：
10.1097/dcr.0000000000000146
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发表时间：
2014
期刊：
影响因子：
3.9
通讯作者：
Akiyoshi T et al.
中科院分区：
文献类型：
--
作者：
Sugimoto K;Kawai M;Takehara K;Tashiro Y;Munakata S;Ishiyama S;Komiyama H;Takahashi M;Kojima Y;Goto M;Tomiki Y;Sakamoto K;Kawasaki S;古田 繭子;Akiyoshi T et al.
背景：直肠胃肠道间质瘤并不常见。游离切除边缘的局部切除提供了足够的治疗，但由于盆腔空间有限，技术困难，经常进行腹会阴切除等扩大手术。目的：我们旨在报告直肠胃肠道间质瘤局部切除新方法的技术细节：改良腹腔镜括约肌间切除技术。设计：本研究是一项回顾性研究。 背景：这项研究是在同一家机构进行的。患者：我们纳入了 3 名直肠胃肠道间质瘤患者，他们在新辅助伊马替尼治疗后接受了该手术。干预：在骶岬附近开始腹膜后内侧到外侧的解剖，在保留自主神经的情况下进行直肠解剖，直至骨盆底进入肛管，而无需进行直肠解剖。 分割肠系膜下动脉。在腹腔镜放大视图下仔细地进行肿瘤和前列腺之间的解剖。接下来，通过经肛门入路将腹腔镜和经肛门解剖进行环向连接，并通过肛门取出直肠。行直肠环形全层局部切除，手工缝制直肠直肠吻合术。主要观察指标：手术的安全性和可行性是本研究的主要观察指标。结果：中位手术时间为180分钟，中位估计失血量为115 mL。无中转及术中并发症，术后出现肠梗阻1例，经保守治疗痊愈。所有患者的切除边缘 (R0) 均为阴性，包括 1 例病理完全缓解。 局限性：该研究因患者数量较少而受到限制。 结论：这种改良的腹腔镜括约肌间切除技术是一种新颖且安全的局部切除非常靠近肛门的直肠胃肠道间质瘤的方法（参见视频，补充数字内容 1，https://links.lww. com/DCR/A139）。
BACKGROUND:Rectal GI stromal tumor is uncommon. Local excision with free resection margins provides adequate treatment, but extended surgery such as abdominoperineal resection has been frequently performed because of technical difficulties in the confined pelvic space.OBJECTIVE:We aimed to report the technical details of a new method of local excision for rectal GI stromal tumor: the modified laparoscopic intersphincteric resection technique.DESIGN:This study was a retrospective analysis.SETTING:This study was performed at a single institute.PATIENTS:We included 3 patients with rectal GI stromal tumor who underwent this procedure following neoadjuvant imatinib therapy.INTERVENTION:Medial-to-lateral retroperitoneal dissection was begun near the sacral promontory, and rectal dissection while preserving autonomic nerves was performed down to the pelvic floor into the anal canal without dividing the inferior mesenteric artery. Dissection between the tumor and prostate was meticulously performed under laparoscopic magnified view. Next, circumferential connection between the laparoscopic and transanal dissections was performed through a transanal approach, and the rectum was extracted through the anus. Circular full-thickness local excision of the rectum and handsewn straight rectoanal anastomosis was performed.MAIN OUTCOME MEASURES:The safety and feasibility of this procedure were the primary outcomes measured by this study.RESULTS:The median operative time was 180 minutes, and the median estimated blood loss was 115 mL. There were no conversions or intraoperative complications, and there was 1 postoperative intestinal obstruction that recovered with conservative therapy. All patients had negative resection margins (R0), including 1 pathological complete response.LIMITATIONS:The study was limited by the small number of patients.CONCLUSIONS:This modified laparoscopic intersphincteric resection technique is a novel and safe method for local excision of rectal GI stromal tumors located very close to the anus (see Video, Supplemental Digital Content 1, https://links. lww. com/DCR/A139).