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Hem-o-lok clip in the pelvic floor reconstruction for laparoscopic abdominoperineal excision of retal cancerObjective To investigate the feasibility of the application of Hem-o-lok clip in the pelvic floor reconstruction for laparoscopic abdominoperineal excision of retal cancer.Methods The clinical data and follow-up results of 5 patients undergoing laparoscopic abdominoperineal excision with Hem-o-lok clip occluding the pelvic peritoneum from July 2014 to December 2014 were collected and analyzed to evaluate the outcome of Hem-o-lok clip occluding the pelvic peritoneum.Results Procedure was completed successfully in all the 5 cases.The mean operation time was(179.0±21.3)min and the mean time of pelvic peritoneum occlusion was(10.5±3.2)min.The mean blood loss was(43.6±32.7)ml and the mean time to intestinal function recovery was(2.4±0.5)d.The mean volume of drainage from presacral space was(342.2±101.5)ml and the mean time of drainage tube remove was(6.2±1.3)d.The mean hospital stay was(7.2±1.5)d.There were no complications such as intestinal obstruction,perineal wound problems and urination disorder happened after operation in all cases.And there was no perineal hernia observed through the examination of computed tomography or dynamic MR imaging in all cases after 3 months of the operation.Conclusion The method of using Hem-o-lok clip to occlude the pelvic peritoneum has significant advantages on simple operation and saving time.And the preliminary results showed good safety.Hem-o-lok clip could be a reliable choice for laparoscopic pelvic floor reconstruction.Part ? Hem-o-lok clip in the pelvic floor reconstruction for laparoscopic Anterior Resection of retal cancerBackground: With the wide application of TME,the positive rate of circumferential resection margin of the colorectal cancer surgery has been decreased;it greatly improved the long-term prognosis.On the other hand,the use of laparoscopic technology becomes better and better,and its application scope has been expanding since.The laparoscopic colorectal cancer abdominal perineal resection technique has also become well developed nowadays.Compared with open surgery,surgical trauma was significantly reduced,at the same time,it also accelerate postoperative recovery while reducing the time of hospitalization.However,while carrying out this surgery,clinicians are often subject to the high technical requirement of laparoscopic suturing and knotting of the pelvic peritoneum,inexperienced operation,and long learning curve…All these may lead to prolonged surgery,pelvic floor reconstruction effect is not exact,and the risk of tearing the pelvic peritoneum after suture.Therefore,some surgeons attempt to operate without closing the pelvic peritoneum,and this might increase the risk of intra-abdominal intestinal in pelvic cavity after operation.I will cause intestinal adhesion in the pelvic floor,resulting in adhesive intestinal obstruction.The postoperative pathology that often require operation in patients with metastatic lymph nodes in rectal membrane after radiotherapy,and intestinal adhesions in the pelvic floor will lead to the small intestine into the radiation region which will result in radioactive enteritis.Thus,find effective methods in laparoscopic closure of the pelvic peritoneum,and pelvic floor reconstruction has become a pressing matter of the moment.Method: A total of 64 patients with rectal cancer underwent laparoscopic resection of rectal cancer treated with low rectal cancer underwent laparoscopic resection of rectal cancer from January 2013 to Feb 2014.According to the method of closing the pelvic floor after the surgery the patients were divided into the traditional continuous suture group(A group),the Hem-o-lok close group(B group)and not to close the pelvic floor peritoneal group(C group).Three groups of clinical data,pathological type and stage had no significant difference(p>0.05),thus are comparable to each other.The collection of patient information including general information,pre-operation tumor stage,the tumor and anal margin distance,whether applicable for supplementary treatment,intra-operative exploration,during the course of operation and histopathological staging.Results: All 64 patients were successfully completed laparoscopic trans-abdominal anterior resection of rectal cancer;no cases were converted to laparotomy.The average operation time and the time of closing pelvic floor of group B were lower than that of group A(P < 0.05),the difference was statistically significant.There was no significant difference between the two groups after the operation in regard with the presacral drainage and the drainage tube indwelling time.No patients had postoperative death.All the patients were discharged within one month after the operation.Only one patient from group C had anastomotic fistula,which lead to abdominal infection,but recovered after two more operation.Another patient had post operation supplementary radiotherapy,which leads to radiation enteritis.All closed pelvic peritoneum patients who,after operation in a reexamination of pelvic CT were confirmed by small intestine did not fall in the presacral space.No pelvic peritoneum dehiscence occurred.Conclusion: Our study shows that laparoscopic colorectal cancer abdominal perineal resection in closed pelvic peritoneum pelvic reconstruction has an important clinical significance,it effectively reduce the operation time,perineal wound complications,perineal hernia pelvic floor and obstruction and radiation enteritis incidence of early and late complications.While selecting the method of closing the pelvic peritoneum,we believe that the traditional method of continuous suture in laparoscopic is very time-consuming,it requires high level of operational proficiency in surgical techniques and instrumentation,it will longer the operation time and increase the operation difficulty.On the other hand,the application of Hem-o-lok technique for closing the pelvic peritoneum has a clear effect;the post operation complication was largely reduced.Therefore,we believe that colorectal cancer in the united laparoscopic abdominal perineal resection application Hem-o-lok Close pelvic peritoneum pelvic floor reconstruction quickly and efficiently.It helps reduce the operation time,decrease postoperative complications,therefore is worthy of promotion. |
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