Abstract：
Objective: To evaluate the safety and efficacy of distal rectal transection by using transanterior obturator nerve gateway (TANG) in laparoscopic radical resection for lower rectal cancers. Methods: A descriptive case series study was performed. Inclusion criteria: (1) patients with primary rectal adenocarcinoma, with the distance of 3-5 cm from tumor to anal verge, with normal anal function before surgery and a desire to preserve anus; (2) laparoscopic radical resection of rectal cancer was performed and the distal rectum was transected using TANG approach. Exclusion criteria: (1) patients with distant metastasis or receiving palliative surgery; (2) the distal rectum was transected using non-TANG approach; (3) patients receiving combined multiple organs resection; (4) patients complicated with other tumors requiring additional treatment during the study. Clinicopathological data of 50 patients with low rectal cancer undergoing laparoscopic resection using TANG approach between January 2019 and December 2020 in Peking University First Hospital were retrospectively collected. Perioperative conditions, length of specific pelvic lines, additional angle and postoperative short-term outcomes were observed and described. Additional angle was defined as the angle between the simulated stapling line with the traditional approach and the real stapling line with the TANG approach. Data following normal distribution were presented as Mean±SD, or M [quartile range (Q(R))] otherwise. Results: All the patients successfully completed laparoscopic surgery without transferring to open or transanal surgery. The median operative time was 193 (80) min and blood loss was 50 (58) ml. All tumors received R0 resection with the distance from the tumor to distal resection margin of 1.7 (0.4) cm and the anastomotic height of 2.0 (0.1) cm. Rectal transection was completed by one cartridge in 52.0% of the cases (26/50) and two cartridges in 48.0% (24/50). Length of the stapling line was 6.6 (1.5) cm. The time to construct the gateway was 8.0 (6.0) min. The vessel damage occurred in 4.0% of the cases (2/50) and none of the cases encountered obturator nerve damage. Inlets of the pelvis in TANG and traditional approach were (9.9±1.3) cm vs. (7.2±1.1) cm (t=24.781, P<0.001). Additional angle of TANG was (15±2) °. The transecting positions on the midline and right edge of the rectum specimen by TANG were 0.6 (0.2) cm and 1.0 (0.2) cm lower than those by the traditional approach. One case (2.0%) died of pulmonary infection on the 17th day after surgery, 2 cases (4.0%) received re-operation and 14 cases (28.0%) had postoperative complications, including anastomotic leakage (7/50, 14.0%), urinary retention (6/50, 12.0%), pelvic infection (2/50, 4.0%) and ileus (2/50, 4.0%). The median postoperative hospital stay was 12 (6) days. Conclusions: Laparoscopic distal rectal transection by using TANG approach is safe and effective in the treatment of low rectal cancer. As an alternative rectal transecting method, TANG has advantages especially for the obese and those with a contracted pelvis and ultralow rectal cancers.
目的： 探讨腹腔镜低位直肠癌根治术中经闭孔神经前入路远端直肠离断技术的安全性及有效性。 方法： 采用描述性病例系列研究方法。纳入标准：（1）原发直肠腺癌，肿瘤距肛缘3~5 cm，术前肛门功能良好，有保肛意愿的患者。（2）行经闭孔神经前入路的远端直肠离断直肠癌根治术。排除标准：（1）有远处转移或行姑息切除患者；（2）其他手术入路的患者；（3）直肠癌脏器联合切除患者；（4）在研究期间合并其他肿瘤需额外治疗者。回顾性收集2019年1月至2020年12月期间于北京大学第一医院接受经闭孔神经前入路行远端直肠离断的50例低位直肠癌患者的临床病理资料，观察患者的围手术期情况、术中骨盆和标本径线测量数据及术后短期疗效。优势角度为经闭孔神经前入路实际切割线与模拟传统TME入路切割线之间角度。计量资料中服从正态分布的数据以x±s表示，非正态分布数据以M（Q(R)）表示。 结果： 全组患者均顺利完成腹腔镜手术，无中转开放和经肛手工吻合。中位手术时间193（80）min，中位术中出血量50（58）ml。所有患者均R(0)切除，远切缘距肿瘤中位距离1.7（0.4）cm，吻合口距肛缘中位距离2.0（0.1）cm。远端直肠单个钉仓离断率52.0%（26/50），两个钉仓离断率48.0%（24/50），切割线长度6.6（1.5）cm。经闭孔神经前入路通路构建中位时间8.0（6.0）min，4.0%（2/50）的患者发生临近血管副损伤，无闭孔神经损伤发生。经闭孔神经前入路与模拟传统入路的骨盆入口宽度分别为（9.9 ± 1.3）cm和（7.2 ± 1.1）cm（t=24.781，P<0.001），经闭孔神经前入路的优势角度（15±2）°，标本中线及右侧线的远切缘距离较模拟传统入路离断位置低0.6（0.2）cm和1.0（0.2）cm。本组1例（2.0%）于术后17 d因肺部感染死亡；二次手术率4%（2/50）；总并发症发生率28.0%（14/50），包括吻合口漏14.0%（7/50）、术后尿潴留12.0%（6/50）、盆腔感染4.0%（2/50）和小肠梗阻4.0%（2/50）。术后住院时间12（6）d。 结论： 经闭孔神经前入路腹腔镜下低位直肠离断技术安全有效，在肥胖、骨盆狭窄、极低位直肠癌等困难状态下更具优势，可作为低位直肠离断方式的一个补充。.
目的： 探讨腹腔镜低位直肠癌根治术中经闭孔神经前入路远端直肠离断技术的安全性及有效性。 方法： 采用描述性病例系列研究方法。纳入标准：（1）原发直肠腺癌，肿瘤距肛缘3~5 cm，术前肛门功能良好，有保肛意愿的患者。（2）行经闭孔神经前入路的远端直肠离断直肠癌根治术。排除标准：（1）有远处转移或行姑息切除患者；（2）其他手术入路的患者；（3）直肠癌脏器联合切除患者；（4）在研究期间合并其他肿瘤需额外治疗者。回顾性收集2019年1月至2020年12月期间于北京大学第一医院接受经闭孔神经前入路行远端直肠离断的50例低位直肠癌患者的临床病理资料，观察患者的围手术期情况、术中骨盆和标本径线测量数据及术后短期疗效。优势角度为经闭孔神经前入路实际切割线与模拟传统TME入路切割线之间角度。计量资料中服从正态分布的数据以x±s表示，非正态分布数据以M（Q(R)）表示。 结果： 全组患者均顺利完成腹腔镜手术，无中转开放和经肛手工吻合。中位手术时间193（80）min，中位术中出血量50（58）ml。所有患者均R(0)切除，远切缘距肿瘤中位距离1.7（0.4）cm，吻合口距肛缘中位距离2.0（0.1）cm。远端直肠单个钉仓离断率52.0%（26/50），两个钉仓离断率48.0%（24/50），切割线长度6.6（1.5）cm。经闭孔神经前入路通路构建中位时间8.0（6.0）min，4.0%（2/50）的患者发生临近血管副损伤，无闭孔神经损伤发生。经闭孔神经前入路与模拟传统入路的骨盆入口宽度分别为（9.9 ± 1.3）cm和（7.2 ± 1.1）cm（t=24.781，P<0.001），经闭孔神经前入路的优势角度（15±2）°，标本中线及右侧线的远切缘距离较模拟传统入路离断位置低0.6（0.2）cm和1.0（0.2）cm。本组1例（2.0%）于术后17 d因肺部感染死亡；二次手术率4%（2/50）；总并发症发生率28.0%（14/50），包括吻合口漏14.0%（7/50）、术后尿潴留12.0%（6/50）、盆腔感染4.0%（2/50）和小肠梗阻4.0%（2/50）。术后住院时间12（6）d。 结论： 经闭孔神经前入路腹腔镜下低位直肠离断技术安全有效，在肥胖、骨盆狭窄、极低位直肠癌等困难状态下更具优势，可作为低位直肠离断方式的一个补充。.
摘要：
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