복강경 직장 절제에서 항문후방절개를 통한 직장적출 및 문합술 3예
Postanal Retrieval and Anastomosis in Laparoscopic Rectal Surgery : Report of 3 Cases
신일용, 이관주, 김형래, 김세준, 김정구, 김형진, 이동호, 이윤석, 이인규, 강원경, 안창혁, 오승택, 김준기, 안창준, 이상철,
소속 상세정보
신일용 ( Shin Il-Yong )
가톨릭대학교 의과대학 외과학교실
이관주 ( Lee Kwan-Ju )
가톨릭대학교 의과대학 외과학교실
김형래 ( Kim Hyung-Rae )
가톨릭대학교 의과대학 외과학교실
김세준 ( Kim Say-June )
가톨릭대학교 의과대학 외과학교실
김정구 ( Kim Jeong-Gu )
가톨릭대학교 의과대학 외과학교실
김형진 ( Kim Hyung Jin )
가톨릭대학교 의과대학 외과학교실
이동호 ( Lee Dong-Ho )
가톨릭대학교 의과대학 외과학교실
이윤석 ( Lee Yoon-Suk )
가톨릭대학교 의과대학 외과학교실
이인규 ( Lee In-Kyu )
가톨릭대학교 의과대학 외과학교실
강원경 ( Kang Won-Kyung )
가톨릭대학교 의과대학 외과학교실
안창혁 ( An Chang-Hyeok )
가톨릭대학교 의과대학 외과학교실
오승택 ( Oh Seung-Tack )
가톨릭대학교 의과대학 외과학교실
김준기 ( Kim Jun-Ki )
가톨릭대학교 의과대학 외과학교실
안창준 ( Ahn Chang-Joon )
가톨릭대학교 의과대학 외과학교실
이상철 ( Lee Sang-Chul )
가톨릭대학교 의과대학 외과학교실
KMID : 0356720080240060487
Abstract
Laparoscopic surgery is popular and widely accepted method for colorectal cancer today. Especially in rectal cancer, laparoscopic TME made surgery safe and feasible with good outcome. But there are still some limits and difficulties in resection and anastomosis of low rectal cancer. We combined laparoscopic TME and posterior approach. Surgery was performed in three low rectal cancer patients. They were prepared in supine position and laparoscopic TME to pelvic floor muscles was performed. After changing the patient to Jack-knife position, post-anal median incision (between the external sphincter and coccyx) and distal rectal resection was done. Through this surgical window, proximal stump was retrieved and resected with the safety margin, and anastomosis with leak test was performed. After a drain keeping, patient’s position was changed back to supine again and laparoscopic irrigation and inspection of operation field was done finally. In the course of recovery, two patients were uneventful, but the rest with FAP experienced postoperative anastomotic leakage and got perineal resection and permanent ileostomy. According to our experience, posterior approach after laparoscopic TME permit right angle resection of distal rectum which is difficult in laparoscopic transabdominal approach. In addition, manual anastomosis with various instruments, Lembert suture, easy drain keeping, accurate fibrin glue apply can also be achieved. No incision on abdomen adds cosmetic advantage. But frequent position changes, need of patience-demanding intracorporeal mesenteric dissection to anastomotic site, and wound discomfort during sitting position right after the operation remain as challenges to consider and solve.
키워드
직장암;복강경;전직장간막 절제술;항문후방;적출
Rectal cancer;Laparoscopy;TME;Postanal;Retrieval
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