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Preservation of the continence function after intersphincteric resection using a prolapsing technique in the patients with low rectal cancer and its clinical prognosis

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Chinese Medical Journal 2008年第20期121卷 2016-2020页

作者： DAI Yong JIANG Jin-bo BI Dong-song JIN Zu-tao SUN Jing-zhong HU San-yuan Shandong Univ Qilu Hosp Dept Gen Surg Jinan 250012 Shandong Peoples R China

Background The technique of intersphincteric resection of tumors combined with coloanal anastomosis has been used to avoid permanent colostomy for patients with a rectal cancer located 〈5 cm from the anal verge. This study aimed at assessing the preservation of continence function of the residual rectum and the clinical prognosis of patients with lower rectal cancer after intersphincteric resection using a prolapsing technique. Methods This study included patients with the following inclusion criteria：（1） pathological evidence of rectal cancer and the tumors within distal margins located 5 cm or less from the anus by preoperative endoscopic examination; （2） no evidence by MRI of infiltration of either the external sphincter, puborectalis or the levator muscle; （3） the patients are eligible for intersphincteric resection and lower coloanal anastomosis with a preoperative biopsy showing the tumors with well-to-moderate differentiation. From January 2000 to June 2004, 23 patients with low rectal cancer were included in this study. We used the standard abdominoperineal approach to perform radical resection of tumors with excision of the mesorectum and total or part of the internal sphincters. The patients were followed for assessment of the function of the residual rectum and of cancer recurrence after the operations. Results The median tumor distance from the anal margin was 4.5 （range 3.5-5.0） cm and the mean distal surgical margin 1.6 （range 1.0-2.0） cm. Cancer was classified into Stage Ⅰ （30.4%）, Stage Ⅱ （47.8%）, and Stage Ⅲ （21.7%） according to the TNM classification. Two patients developed anastomotic fistula after the surgical resection and 2 patients （8.7%） developed later stages of anastomotic stricture at the site of coloanal anastomosis. The median follow-up period was 31.5 months （range 12-54） and 2 patients （8.7%） developed local recurrence. Three deaths were associated with distal organ metastasis. Twenty patients （87.0%） have maintained competence to

关键词： rectal cancer anus-sparing operation intersphincteric resection continence function

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Robotic-assisted proctosigmoidectomy for Hirschsprung’s disease:A multicenter prospective study

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World Journal of Gastroenterology 2023年第23期29卷 3715-3732页

作者： Meng-Xin Zhang Xi Zhang Xiao-Pan Chang Ji-Xiao Zeng Hong-Qiang Bian Guo-Qing Cao Shuai Li Shui-Qing Chi Ying Zhou Li-Ying Rong Li Wan Shao-Tao Tang Department of Pediatric Surgery Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022Hubei ProvinceChina Department of Pediatric Surgery Guangzhou Women and Children’s Medical CenterGuangzhou Medical UniversityGuangzhou 510623Guangdong ProvinceChina Department of General Surgery Wuhan Children’s HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430019Hubei ProvinceChina

BACKGROUND Robotic surgery is a cutting-edge minimally invasive technique that overcomes many shortcomings of laparoscopic techniques,yet few studies have evaluated the use of robotic surgery to treat Hirschsprung’s disease(HSCR).AIM To analyze the feasibility and medium-term outcomes of robotic-assisted proctosigmoidectomy(RAPS)with sphincter-and nerve-sparing surgery in HSCR *** From July 2015 to January 2022,156 rectosigmoid HSCR patients were enrolled in this multicenter prospective *** sphincters and nerves were spared by dissecting the rectum completely from the pelvic cavity outside the longitudinal muscle of the rectum and then performing transanal Soave pull-through *** outcomes and continence function were *** No conversions or intraoperative complications *** median age at surgery was 9.50 months,and the length of the removed bowel was 15.50±5.23 *** total operation time,console time,and anal traction time were 155.22±16.77,58.01±7.71,and 45.28±8.15 *** were 25 complications within 30 d and 48 post-30-d *** children aged≥4 years,the bowel function score(BFS)was 17.32±2.63,and 90.91%of patients showed moderate-to-good bowel *** postoperative fecal continence(POFC)score was 10.95±1.04 at 4 years of age,11.48±0.72 at 5 years of age,and 11.94±0.81 at 6 years of age,showing a promising annual *** were no significant differences in postoperative complications,BFS,and POFC scores related to age at surgery being≤3 mo or>3 *** RAPS is a safe and effective alternative for treating HSCR in children of all ages;it offers the advantage of further minimizing damage to sphincters and perirectal nerves and thus providing better continence function.

关键词： Robotic-assisted Hirschsprung’s disease continence function Sphincter Nerve

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