【摘要翻译】腹腔镜乙状结肠切除、直肠固定术治疗直肠脱垂
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Laparoscopic resection rectopexy for rectal prolapse
Kessler H./Hohenberger W. DIS. COLON RECTUM 2005, 48/9 (1800-1801)
INTRODUCTION: The laparoscopic approach in suture rectopexy with sigmoid resection is appealing as surgery is mainly confined to the pelvis. METHODS: The procedure is performed in modified lithotomy position using five trocars. In the case reported, the inferior mesenteric artery is divided distally to the left colic artery branch. The sigmoid colon is mobilized medially and may be mobilized laterally up to the descending colon, depending on the extent of resection. The splenic flexure remains in place. The rectum is mobilized from the presacral fascia down to the pelvic floor, sparing the hypogastric nerves. The rectum is transected in its upper third and the colonic stump pulled outside after enlarging the left lower abdominal incision to a length of 5 cm. The colorectal anastomosis is established intracorporeally in a double-stapling technique. Three 2-0 braided nonabsorbable sutures are placed to attach the right lateral stalks of the rectum to the presacral fascia. Proctoscopic examination has to ensure that there is no luminal compromise or air leakage. RESULTS: The videotape reports about a 37-year-old male patient with a rectal prolapse of 8 cm in length. First symptoms had occurred in childhood. He reported about temporary constipation and repeated rectal bleeding. During surgery, an elongated sigmoid was found. Laparoscopic sigmoid resection and suture rectopexy were carried out. There were no intraoperative or postoperative complications. The patient was discharged from the hospital on the sixth postoperative day. CONCLUSION: Laparoscopic resection rectopexy is safely feasible as a minimally-invasive treatment option for rectal prolapse.
腹腔镜乙状结肠切除、直肠固定术治疗直肠脱垂
引言
：由于直肠脱垂手术操作主要限于盆腔，因此经腹腔镜途径进行乙状结肠切除、直肠缝合固定术受到人们的关注。方法：手术选择改良的膀胱截石位，以5个trocar孔进行操作。肠系膜下动脉在远侧分出左结肠动脉分支，根据切除范围，从两侧分离乙状结肠直至降结肠。结肠脾曲保持在位，沿骶前筋膜分离直肠至盆底，保留腹下神经。于直肠上1/3横断直肠，扩大左下腹切口至5cm后将结肠残端拖出体外。利用双吻合技术在体内行结-直肠吻合。用2-0不可吸收缝线缝合3针将右侧直肠蒂固定于骶前筋膜。肛门镜检查确保缝合部没有遗留裂隙或漏气。结果：录像报告一名37岁男性患者，直肠脱垂长度达8cm。首次症状出现于儿童期，表现为短时期便秘和反复直肠出血。术中发现乙状结肠冗长，实施了腹腔镜乙状结肠切除、直肠缝合固定术。术中或术后未出现并发症。该患者于术后第6天出院。结论:作为直肠脱垂的微创治疗手段，腹腔镜直肠固定术是安全可行的。
Kessler H./Hohenberger W. DIS. COLON RECTUM 2005, 48/9 (1800-1801)
INTRODUCTION: The laparoscopic approach in suture rectopexy with sigmoid resection is appealing as surgery is mainly confined to the pelvis. METHODS: The procedure is performed in modified lithotomy position using five trocars. In the case reported, the inferior mesenteric artery is divided distally to the left colic artery branch. The sigmoid colon is mobilized medially and may be mobilized laterally up to the descending colon, depending on the extent of resection. The splenic flexure remains in place. The rectum is mobilized from the presacral fascia down to the pelvic floor, sparing the hypogastric nerves. The rectum is transected in its upper third and the colonic stump pulled outside after enlarging the left lower abdominal incision to a length of 5 cm. The colorectal anastomosis is established intracorporeally in a double-stapling technique. Three 2-0 braided nonabsorbable sutures are placed to attach the right lateral stalks of the rectum to the presacral fascia. Proctoscopic examination has to ensure that there is no luminal compromise or air leakage. RESULTS: The videotape reports about a 37-year-old male patient with a rectal prolapse of 8 cm in length. First symptoms had occurred in childhood. He reported about temporary constipation and repeated rectal bleeding. During surgery, an elongated sigmoid was found. Laparoscopic sigmoid resection and suture rectopexy were carried out. There were no intraoperative or postoperative complications. The patient was discharged from the hospital on the sixth postoperative day. CONCLUSION: Laparoscopic resection rectopexy is safely feasible as a minimally-invasive treatment option for rectal prolapse.
腹腔镜乙状结肠切除、直肠固定术治疗直肠脱垂
引言
：由于直肠脱垂手术操作主要限于盆腔，因此经腹腔镜途径进行乙状结肠切除、直肠缝合固定术受到人们的关注。方法：手术选择改良的膀胱截石位，以5个trocar孔进行操作。肠系膜下动脉在远侧分出左结肠动脉分支，根据切除范围，从两侧分离乙状结肠直至降结肠。结肠脾曲保持在位，沿骶前筋膜分离直肠至盆底，保留腹下神经。于直肠上1/3横断直肠，扩大左下腹切口至5cm后将结肠残端拖出体外。利用双吻合技术在体内行结-直肠吻合。用2-0不可吸收缝线缝合3针将右侧直肠蒂固定于骶前筋膜。肛门镜检查确保缝合部没有遗留裂隙或漏气。结果：录像报告一名37岁男性患者，直肠脱垂长度达8cm。首次症状出现于儿童期，表现为短时期便秘和反复直肠出血。术中发现乙状结肠冗长，实施了腹腔镜乙状结肠切除、直肠缝合固定术。术中或术后未出现并发症。该患者于术后第6天出院。结论:作为直肠脱垂的微创治疗手段，腹腔镜直肠固定术是安全可行的。
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