CAJ | 학술논문

目的：探讨在腹部无切口的腹腔镜下直肠癌根治术中，经肛门取出标本时，防止癌肿在移出肛门过程中，癌细胞脱落而残留于直肠远端的防范措施。方法手术中充分游离直肠、乙状结肠后于肿瘤下2 cm处用Endo-GIA（腹腔镜直线切割闭合器）切断直肠，直肠远端经肛门拖出，切开闭合缘，经剪开肠管内将一保护套送入腹腔，在腹腔镜监视下，经保护套内将瘤体及乙状结肠脱出体外，切除瘤体。结果所有手术均采用防癌肿脱落措施取出标本，随访1~3年无吻合口肿瘤种植病例。结论经自然通道保护性取出标本的腹腔镜直肠癌根治术可预防术中取出标本过程中癌肿脱落种植于直肠远端的事件发生，该措施安全有效。
목적：탐토재복부무절구적복강경하직장암근치술중，경항문취출표본시，방지암종재이출항문과정중，암세포탈락이잔류우직장원단적방범조시。방법수술중충분유리직장、을상결장후우종류하2 cm처용Endo-GIA（복강경직선절할폐합기）절단직장，직장원단경항문타출，절개폐합연，경전개장관내장일보호투송입복강，재복강경감시하，경보호투내장류체급을상결장탈출체외，절제류체。결과소유수술균채용방암종탈락조시취출표본，수방1~3년무문합구종류충식병례。결론경자연통도보호성취출표본적복강경직장암근치술가예방술중취출표본과정중암종탈락충식우직장원단적사건발생，해조시안전유효。
Objective Clinical study of preventive measures of cancer cells shedding in laparoscopic radical operation on rectal carcinoma when taking a sample from the anus.MethodsFirst, to separate the rectum and sigmoid colon completely; second, to cut the end of rectum with Endo-GIA on 2 cm long far from tumor near the rectum; third, to pull out the distal rectum through anus and cut closure margin; finally, under laparoscopic visualization, to push a protective sleeve into the abdominal cavity and pull tumor and sigmoid colon out of the anus through the protective sleeve, then cut away the tumor.Results All 59 cases of laparoscopic radical resection follow-up 1~3 years with no anastomotic due to taking above steps. ConclusionPreventive measures of cancer cells shedding in laparoscopic radical operation on rectal carcinoma when taking a sample from the anus such as taking protection sleeve are safe and effective measures.