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中华腔镜外科杂志(电子版) ›› 2022, Vol. 15 ›› Issue (05): 311 -314. doi: 10.3877/cma.j.issn.1674-6899.2022.05.013

病例报告

机器人经肛切除临床完全缓解的直肠癌一例
邹贵军1, 袁新普1, 马冰1, 宋舟1, 黄晓天1, 曹震1, 王麦换1, 张朝军1,()   
  1. 1. 100853 北京,解放军总医院第一医学中心普通外科医学部
  • 收稿日期:2022-08-16 出版日期:2022-10-30
  • 通信作者: 张朝军
  • 基金资助:
    国家自然科学基金(81972320)

Robotic transanal resection of rectal cancer with clinical complete response: a case report

Guijun Zou1, Xinpu Yuan1, Bing Ma1, Zhou Song1, Xiaotian Huang1, Zhen Cao1, Maihuan Wang1, Chaojun Zhang1,()   

  1. 1. Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2022-08-16 Published:2022-10-30
  • Corresponding author: Chaojun Zhang
目的

探讨达芬奇机器人经肛局部全层切除术(full-thickness local excision, FTLE)治疗新辅助放化疗(neoadjuvant chemoradiation therapy, NCRT)后临床完全缓解(clinical complete remission, cCR)的直肠癌的安全性和可行性。

方法

选取NCRT后cCR的直肠癌患者一例,完善术前检查,排除绝对手术禁忌,实施达芬奇机器人经肛FTLE。

结果

手术顺利,手术时间约180 min,术中出血量约10 ml,术后3 d出院,术后病理分期ypT0N0M0,随访4周无不适。

结论

达芬奇机器人经肛FTLE治疗NCRT后cCR的直肠癌是安全、可行的,更多证据尚需大规模临床研究。

Objective

The purpose of this study was to investigate the safety and feasibility of da Vinci robotic transanal full-thickness local excision for rectal cancer with complete clinical remission after neoadjuvant chemoradiotherapy.

Methods

A patient with rectal cancer who had complete clinical remission after neoadjuvant chemoradiotherapy underwent transanal full-thickness local excision using the da Vinci Si surgical system.

Results

The operation was successful with a duration of about 180 min and an intraoperative bleeding of about 10 ml. The patient was discharged 3 days later. The postoperative pathological stage was ypT0N0M0.

Conclusions

It is safe and feasible to treat rectal cancer with complete clinical remission after neoadjuvant chemoradiotherapy by transanal full-thickness local excision using the da Vinci Si surgical system. More evidence is needed in large-scale clinical studies.

图1 新辅助放化疗前后结肠镜、MRI-T2W检查对比注:A.NCRT治疗前结肠镜显示距肛门约2 cm可见环周1/3隆起型、不规则溃疡病变,表面凸凹不平;B.治疗前MRI-T2W显示距肛门约22 mm下段直肠肠壁不对称增厚,管腔狭窄,呈稍长T1、稍长T2异常信号;C.治疗后结肠镜显示原病灶呈扁平、白色瘢痕,毛细血管扩张症;D.治疗后MRI-T2W显示病变较前明显缩小,未见明确残留肿瘤物质
图2 达芬奇机器人经肛局部全层切除术注:A、B.建立手术操作平台;C.标记切除范围;D.由病变一侧全层切开:E、F.全层完整切除病变;G.全层缝合;H.标本固定
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