[1]李佑翻译.经脐孔-直肠联合途径腹腔镜人乙状结肠切除——原创技术[J].中国微创外科杂志,2009,09(12):1066-1068.
　Jol Leroy Jacques Marescaux.Laparoscopic Sigmoidectomy in Human by Hybrid Transombilical and Transrectal Original Technique[J].Chinese Journal of Minimally Invasive Surgery,2009,09(12):1066-1068.
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经脐孔-直肠联合途径腹腔镜人乙状结肠切除——原创技术()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
09
期数:
2009年12期
页码:
1066-1068
栏目:
国外专稿
出版日期:
2009-12-31

文章信息/Info

Title:
Laparoscopic Sigmoidectomy in Human by Hybrid Transombilical and Transrectal Original Technique
作者:
李佑翻译
上海交通大学医学院附属瑞金医院普外科上海市微创外科临床医学中心，上海200025
Author(s):
Jol Leroy Jacques Marescaux
Department of Digestive and Endocrinologic Surgery, Hospital, IRCAD 67091 Strasbourg Cedex, France
关键词:
NOTES; 腹腔镜外科; 乙状结肠切除
Keywords:
NOTES ; Laparoscopic surgery;  Sigmoidectomy
分类号:
R656.9
文献标志码:
A
摘要:
经人体自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)目前取得了令人满意的成果，2008年我们实施了世界首例经肛乙状结肠切除术。在NOTES手术中，关键难题在于如何建立有效的手术牵拉和操作的空间，我们利用手术器具有的金属磁性这一特性采用体内外放置磁铁，对手术部位进行牵引，同时采用带有活动关节的手术器械，这些都有助于手术操作空间的良好暴露，并在实际上取得良好的效果。在首例人体手术中，在脐孔放置18 mm的多操作孔道的穿刺套管，在乙结肠肠腔内放置磁铁棒，同时在体外放置强力磁铁以牵引乙结肠达到良好的手术暴露。将切下的乙结肠段经肛门取出体外。利用自然人体的腔道，使我们可以减少trocar的使用，并且也可以和腹腔镜操作相互配合，使腹腔镜外科“常规”技术操作变得更加方便。这种技术有潜在的应用前景，我们认为可以首先在结肠良性肿瘤的病例甚至早期的小病灶结肠癌中开展。
Abstract:
The endoscopic transluminal abdominal surgery by the natural orifices (NOTES) has nowadays some satisfactory results and initial success. In 2008, we successfully realized the first laparoscopic transluminal sigmoidectomy for a benign case in the world with a hybrid technique combining a single transombilical trocart and a transanal approach . For the NOTES, the major difficulty is to realize a perfect operative exposition and to reproduce the necessary triangulation for the surgical gestes. The application of intraluminal ironic tube controlled by a puissant magnet and the devices with the articulable joints permits the satisfactory surgical exposition. During the first operation in human, we introduced transombilically the single trocart which with multiple operative canals of 18mm diameters, while the magnet devices both intraluminally and externally maintaining the perfect exposition of the sigmoid. Finally, we pull out the dissected sigmoid by the transanal approach. The natural orifice approach benefits the reduce of numbers of trocarts and the cooperation with laparoscopic graspe gestes. It makes sometimes easier the laparoscopic procedures. We suggest the potential application of this technique in those benign cases and even small and early stage colonic cancer.

参考文献/References:

[1]Rattner D. Introduction to NOTES white paper. Surg Endosc，2006，20(2):185.
[2]Buess G, Thiess R, Gunther M. Endoscopic opérative procédures for the removal of rectal polyps. Coloproctology,1984,6: 254-259.
[3]Leroy J, Cahill RA, Perreta S, et al. Single port sigmoidectomy in an experimental model with survival.Surg Innov, 2008,15(4):260-265.
[4]Perretta S, Sereno S, Forgione A, et al. A new method to close the gastrotomy by using a cardiac septal occluder: longterm survival study in a porcine model. Gastrointest Endosc, 2007,66(4):809-813.
[5]Leroy J, Cahill RA, Perretta S, et al. Natural orifice translumenal endoscopic surgery (NOTES) applied totally to sigmoidectomy: an original technique with survival in a porcine model. Surg Endosc,2009,23(1) :24-30.
[6]Leroy J, Cahill RA, Asakuma M, et al. Single access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg ,2009,144(2):218-224.
[7]Sylla P, Willingham FF, Sohn DK, et al. NOTES rectosigmoidectomyresection using transanal endoscopic microsurgery (TEM) with transgastric endoscopic assistance: a pilot study in swine. Gastrointest Surg, 2008，12(10): 1717-1723.
[8]Whiteford MH, Denk PM, Swanstrm LL. Feasability of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc, 2007，21(10):1870-1874.
[9]Bucher P, Pugin F, Morel P. Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis, 2008 ,23(10):1013-1016.
[10]Lacy AM, Delgado S， Rojas A, et al. MANOS radical sigmoidectomy: report of a transvaginal resection in the human. Surg Endosc, 2008,22:1717-1723.
[11]Cahill RA, Perretta S, Leroy J, et al. Lymphatic mapping and sentinel node biopsy in the colonic mesentry by naturel orifice endoscopic surgery (NOTES). Ann Surg Oncol, 2008,15(10): 2677-2683.
[12]Cahill R, Bembeneck A, Sirop S, et al. Sentinel node biopsy for individualization of surgical strategy for cure of earlystage colon cancer. Ann Surg Oncol,2009,16(8)2170-2180.
[13]Cahill R, Asakuma M, Perretta S, et al. Supplementation of endoscopic submucosal dissection with sentinel node biopsy performed by natural orifice transluminal endoscopic surgery (NOTES). Gastrointest Endosc, 2009,69(6):1152-1160.
[14]Cahill RA, Leroy J, Dallemagne B, et al. Could sentinel node biopsy provide the oncological propriety for endoscopic resection of early stage colon cancer? BMC Surg，2008，8:17.
[15]Cahill RA, Leroy J, Marescaux J. Localised resection for colon cancer. Surg Oncol，2009，18（4）:334-342
[16]Cahill RA, Perretta S, Leroy J. Lymphatic Mapping and Sentinel Node Biopsy in the Colonic Mesentery by Natural Orifice Transluminal Endoscopic Surgery (NOTES). Surg Oncol，2008，15（10）:2677-2683.

备注/Memo

备注/Memo:
作者简介：Joel Leroy：法国斯特拉斯堡欧洲远程医学研究所学术副主任，腹腔镜与消化外科教授，WebSurg（世界著名腹腔镜外科网站）编委。Jacques Marescaux：法国斯特拉斯堡大学医院欧洲远程医学研究所主席，欧洲腔内手术学会主席，WebSurg总编辑，斯特拉斯堡大学消化与内分泌外科主任，前任法国消化外科学会秘书长，法国医学发展评估委员会主席，斯特拉斯堡大学医学院副院长
更新日期/Last Update: 2014-01-08