Laparoscopic resection of a tumour in the ischiorectal fossa - a video vignette.
Laparoscopic resection of a tumour in the ischiorectal fossa - a video vignette.
复制标题
腹腔镜切除坐骨直肠窝肿瘤 - 视频小插图。
DOI：
10.1111/codi.13806
复制
发表时间：
2017
期刊：
影响因子：
3.4
通讯作者：
Ueno M
中科院分区：
文献类型：
--
作者：
Tokunaga R;Akiyoshi T;Hiyoshi Y;Fukunaga Y;Ueno M
坐骨直肠窝的肿瘤切除术具有挑战性，因为它的可视性差，而且靠近直肠、膀胱和提肛肌。传统的经腹开放入路进入坐骨直肠窝受限[1]。在这里，我们展示了腹腔镜切除一个巨大的肿瘤在坐骨直肠窝喂养的阴部内动脉。我们暴露闭孔内肌作为外侧缘，膀胱肌层作为内侧缘。闭孔神经保留，闭孔血管切除。在背侧，由于与肿瘤粘连，切除了髂内动脉，但保留了髂内静脉。将覆盖肿瘤的提肛肌沿圆周方向分开，这样可以进入坐骨直肠窝。在骶棘韧带下切除肿瘤的阴部内动、静脉。无排尿和/或排便问题。病理诊断为脂肪瘤，手术切缘清晰。这种腹腔镜切除术的优点包括切口长度小（4 cm），手术视野良好，术中失血量最少。后方入路或腹后联合入路治疗坐骨直肠肿瘤的有效性已有报道[2，3]。然而，尽管切口长，这些传统入路的可视性较差，尤其是对于延伸至上提肌和旁间隙的肿瘤。据我们所知，这是第一次成功的腹腔镜肿瘤切除术在坐骨直肠窝的报告。
Tumor resection in the ischiorectal fossa is challenging due to poor visibility and proximity to the rectum, bladder, and levator ani muscle. Access to the ischiorectal fossa is limited in the conventional open transabdominal approach [1]. Here, we demonstrate the laparoscopic resection of a large tumor in the ischiorectal fossa fed by the internal pudendal artery. We exposed the obturator internus muscle as the lateral border and the muscular layer of the bladder as the medial border. The obturator nerve was preserved, but the obturator vessels were resected. Dorsally, the internal iliac artery was resected due to adhesion to the tumor, but the internal iliac vein was preserved. The levator ani muscle covering the tumor was divided circumferentially, which enabled access to the ischiorectal fossa. The internal pudendal artery and vein feeding the tumor were resected below the sacrospinous ligament. There were no urinary and/or defecation problems. The tumor was pathologically diagnosed as a lipoma with clear surgical margins. The benefits of this laparoscopic resection include the small incision length (4 cm), good view of the operative field, and minimal intraoperative blood loss. The usefulness of the posterior approach or a combined abdominal and posterior approach for ischiorectal tumors has been reported previously [2, 3]. However, these conventional approaches provide poor visibility despite the long incisions, especially for tumors extending to the supralevator and paravesical space. To our knowledge, this is the first report of successful laparoscopic tumor resection in the ischiorectal fossa.