摘要
经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)是近几年微创外科(特别是腹腔镜结直肠外科)领域发展最为迅速的新技术,不仅克服了传统开腹手术大切口带来的相关并发症和困扰,而且符合现代医学减少创伤应激的新理念,可以达到更加微创、切口更小、疼痛更轻、恢复更快且美观的效果,是体现加速康复外科(enhanced recovery after surgery,ERAS)思想的新技术。顺利完成腹腔镜NOSES的消化道重建,首先,需要以经自然腔道(直肠或阴道)取出标本为前提和重要手术环节,可借助硬质、软质工具或使用双重软质工具等适当扩张自然腔道(直肠或阴道),使标本容易取出,且须遵循无菌、无瘤原则进行手术操作。其次,根据肿瘤部位、大小、浸润深度、体型、肠管粗细等选择恰当的NOSES的消化道重建方式,包括完全腹腔内肠管吻合、管型吻合器对端吻合和经肛手工缝合吻合,并探讨了外翻式、拉出切除式、离断式NOSES的各种消化道重建方式。再次,要熟悉腹腔镜下外科基本操作,合理选用各种吻合器及其缝线。最后强调的是需要一支稳定、配合默契的腹腔镜手术团队,确保NOSES高效、熟练、安全地开展和完成。
Natural orifice specimen extraction surgery(NOSES)is one of the most rapidly developed new techniques in the field of minimally invasive surgery(especially laparoscopic colorectal surgery)in recent years.It not only overcomes the complications and perplexities associated with the large incision of traditional laparotomy,but also conforms to the new concept of reducing traumatic stress in modern medicine.NOSES can achieve more minimally invasive,less incision,less pain,faster recovery and beautiful effect.It is a new technique embodying the idea of enhanced recovery after surgery(ERAS).The successful reconstruction of the gastrointestinal tract in laparoscopic surgery with NOSES requires firstly the removal of specimens through the natural orifice(rectum or vagina)as the prerequisite and important part of the operation,the natural orifice can be expanded properly with the help of hard or soft tools or using double tools,so that the specimen can be easily removed and the operation must be carried out according to the principle of asepsis and tumor-free.Secondly,according to the site,size and depth of invasion of tumor,body type and size of intestinal canal,proper reconstruction of gastrointestinal tract in laparoscopic surgery with NOSES was selected,which including complete intra-abdominal anastomosis,end-to-end anastomosis with tubular stapler and manual anastomosis through anus.NOSES can be divided into three types of gastrointestinal tract reconstruction:everted,pull-out and disconnection of the NOSES.The third is to be familiar with the basic operation of laparoscopic surgery,the rational choice of various staplers and their suture.The last is to emphasize the need for a stable and well co-ordinated laparoscopy team,ensure that the NOSES procedure is performed efficiently,expertly,and safely.
作者
陈创奇
戴伟钢
Chen Chuangqi;Dai Weigang(The Second Department of Gastrointestinal Surgery,Gastrointestinal Surgery Center,the First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,Guangdong,China)
出处
《消化肿瘤杂志（电子版）》
2020年第3期163-169,共7页
Journal of Digestive Oncology(Electronic Version)
基金
广东省科技计划项目(2010B080701106、2013B021800131)
广州市科技计划项目(201604020003)。
关键词
经自然腔道取标本手术
腹腔镜手术
结直肠肿瘤
手术方式
Natural orifice specimen extraction surgery
Laparoscopy
Colorectal tumor
Surgical procedure
