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目的探讨手术机器人行直肠前切除经肛门拖出直肠标本的手术方法。方法回顾性分析沈阳军区总医院普通外科于2012年7~12月间16例直肠肿瘤病人采用达芬奇手术机器人系统行直肠前切除并经肛门拖出直肠标本的临床资料。结果 16例中男9例,女7例。13例为直肠癌,2例为直肠绒毛管状腺瘤,1例为直肠神经内分泌瘤。年龄46~84岁,体重指数(BMI)18.8~28.8。均顺利完成手术,手术时间160~610 min,平均(220.4±24.5)min,术中出血量均在50 mL以下,术后排气时间18~74 h,平均(27.3±7.5)h,术后住院时间5~10 d,平均(6.2±2.1)d,每例获取淋巴结2~39枚,平均(18.2±7.6)枚。TNM分期:Ⅰ期2例,Ⅱ期7例,Ⅲ期4例。所有标本切缘均为阴性。所有病例无局部手术并发症。结论采用达芬奇手术机器人系统切除直肠并经肛门拖出直肠标本的手术方法是安全可行的。
Objective To investigate the surgical technique of rectal removal of the rectum by rectal removal of a rectal specimen by a surgical robot. Methods The clinical data of 16 patients with rectal cancer treated by Da Vinci surgical robotic system underwent rectal anastomosis and rectal anastomosis were retrospectively analyzed in the General Surgery Department of Shenyang Military Region General Hospital from July to December in 2012. Results Among 16 cases, 9 were males and 7 were females. 13 were rectal cancer, 2 were rectal villous tubular adenomas, and 1 was rectal neuroendocrine tumors. Age 46 to 84 years old, body mass index (BMI) 18.8 ~ 28.8. The operation time was 160-610 min with an average of (220.4 ± 24.5) min. The mean intraoperative blood loss was less than 50 mL and the postoperative effusion time was 18-74 h (mean, 27.3 ± 7.5 h) The hospitalization time was 5 to 10 days, with an average of (6.2 ± 2.1) days. Two to 39 lymph nodes were obtained in each case, with an average of (18.2 ± 7.6). TNM staging: Ⅰ in 2 cases, Ⅱ in 7 cases, Ⅲ in 4 cases. All specimens were negative margin. No case of local surgical complications. Conclusion It is safe and feasible to use da Vinci surgical robot system to remove the rectum and pull the rectal specimen through the anus.