gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2017-0-4-7-16gnck-327Research ArticleСТАТЬЯ НОМЕРАLEADING ARTICLEЛАПАРОСКОПИЧЕСКИЕ ОПЕРАЦИИ С РУЧНОЙ АССИСТЕНЦИЕЙ ПРИ РАКЕ ТОЛСТОЙ КИШКИ -ИДЕАЛЬНЫЙ МИНИ-ИНВАЗИВНЫЙ СПОСОБ ВМЕШАТЕЛЬСТВА? АНАЛИЗ ОПЫТА ЛЕЧЕНИЯ 459 ПАЦИЕНТОВ В ОДНОМ ЛЕЧЕБНОМ УЧРЕЖДЕНИИHAND-ASSISTED LAPAROSCOPIC SURGERY FOR THE CANCER OF THE LEFT COLON AND RECTUM - AN IDEAL OPTION OF MINIMALLY INVASIVE SURGERY? SINGLE CENTRE EXPERIENCE WITH 459 CASESСамалавичюсНаримантас Э.SamalaviciusNarimantas E.narimantas.samalavicius@gmail.comКулесийЗигимантасKuliesiusZygimantasnoemail@neicon.ruДульскасАудриусDulskasAudriusnoemail@neicon.ruКулявасЮстасKuliavasJustasnoemail@neicon.ruРудинскайтГидреRudinskaiteGiedrenoemail@neicon.ruСмолскасЭдгарасSmolskasEdgarasnoemail@neicon.ruКилиусАфредасKiliusAfredasnoemail@neicon.ruПетрулисКестутисPetrulisKestutisnoemail@neicon.ruKlaipeda University Hospital; Vilnius UniversityРоссияKlaipeda University Hospital; Vilnius UniversityRussian FederationKlaipeda University Hospital; Center of General Surgery, Republican Vilnius University HospitalРоссияKlaipeda University Hospital; Center of General Surgery, Republican Vilnius University HospitalRussian FederationKlaipeda University HospitalРоссияKlaipeda University HospitalRussian Federation20173012201704716Copyright © Самалавичюс Н.Э., Кулесий З., Дульскас А., Кулявас Ю., Рудинскайт Г., Смолскас Э., Килиус А., Петрулис К., 20172017Самалавичюс Н.Э., Кулесий З., Дульскас А., Кулявас Ю., Рудинскайт Г., Смолскас Э., Килиус А., Петрулис К.Samalavicius N.E., Kuliesius Z., Dulskas A., Kuliavas J., Rudinskaite G., Smolskas E., Kilius A., Petrulis K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/327

Методика лапароскопических операций с ручной ассистенцией (HALS) была введена в клиническую практику почти три десятилетия назад, вскоре после внедрения стандартной лапароскопической хирургии HALS сочетает в себе преимущества лапароскопических (мини-инвазивных) методик и открытых вмешательств. Несмотря на изрядное количество исследований, на сегодняшний день истинное место малоинвазивных операций с ручной ассистенцией определить сложно. Целью нашего исследования явилось изучение собственного опыта лечения пациентов, страдающих раком левых отделов ободочной кишки и прямой кишки, используя технологию HALS. МЕТОДЫ. В исследовании проведён ретроспективный анализ проспективно собранных данных 459 пациентов, страдающих раком толстой кишки и подвергшихся лапароскопическим с ручной ассистенцией резекциям левых отделов ободочной кишки и прямой кишки в специализированном лечебном учреждении -National Cancer Institute, с 1 января 2006 года по 31 декабря 2016. В анализ были включены все пациенты с гистологически-подтверждённым раком левых отделов ободочной кишки и прямой кишки, перенесшие операции с ручной ассистенцией. РЕЗУЛЬТАТЫ. Средний возраст пациентов составил 64,14 ± 9,75 лет. Больные были сопоставимы по полу: женщин - 232 (50,5 %), мужчин - 227 (49,5 %). Средняя продолжительность послеоперационного койко-дня была 6,7 (от 2-х до 34-х) дней. В 5 (1,1 %) случаях была произведена конверсия доступа в открытый. При гистологическом исследовании удалённого препарата, в среднем, обнаруживалось 15 ± 12 лимфатических узлов, значение варьировало от 8 до 90. Распределение пациентов по стадиям рака было равномерным при I, II, и III стадии 133 (28,9 %), 139 (30,3 %), 151 (32,9%), при этом у 36 (7,8%) больных была IV стадия. 244 пациента подверглись операциям по поводу рака ободочной кишки левой локализации (резекция сигмовидной кишки или левосторонняя гемиколэктомия), в 215 (46,8 %) случаях выполнялись вмешательства по поводу рака прямой кишки. Послеоперационные осложнения развились у 28 (6,1 %) больных, 8 (1,7 %) из которых нуждались в повторных операциях из-за несостоятельности межкишечного анастомоза и формирования внутрибрюшного абсцесса. 2 (0,4 %) пациента скончались в течение 30 дней послеоперационного периода. ЗАКЛЮЧЕНИЕ. Как показывает наш опыт, HALS надежная и удобно осуществимая малоинвазивная методика хирургического лечения рака левых отделов ободочной кишки и прямой кишки, с непродолжительной кривой обучения и длительностью операции, позволяющая добиться необходимой радикальности онкологической резекции и низкой частоты послеоперационных осложнений. Она может быть использована как стандарт лечения при данной патологии, либо как «мост» от открытой хирургии к традиционной лапароскопической.

BACKGROUND/OBJECTIVE. Hand-assisted laparoscopic surgery (HALS) has been introduced into clinical practice almost three decades ago, very soon after the introduction of conventional laparoscopic surgery. It combines the advantages of both laparoscopic (minimally invasive) and open surgery. Despite a good piece of data in the medical literature, the clear place of this kind of laparoscopic surgery today is not easy to delineate. Our study aimed to review single centre experience in treating patients with left colon and rectal cancers using HALS. METHODS. This study was a retrospective analysis of prospectively collected data of 459 patients undergoing hand assisted laparoscopic colorectal surgery for left colon and rectal cancer, in a single tertiary care institution, National Cancer Institute, from January 1, 2006, to December 31, 2016. All consented patient with confirmed invasive cancer of left colon and rectum undergoing HALS were included in the analysis. RESULTS. The patients’ mean age was 64.14±9.75 years. Female and male ratio was similar: 232 (50,5 %) versus 227 (49,5 %). The mean length of postoperative hospital stay was 6.7 (from 2 to 34) days. There were 5 (1,1 %) conversions to open surgery. Histological examination revealed mean lymph node harvest to be 15 ± 12, ranging from 8 to 90. Stage I, II and III cancer was similar in distribution accounting for 133 (28,9%), 139 (30,3 %), 151 (32,9 %) patients respectively and 36 (7,8 %)patients with stage IV. 244 (53,2) of patients underwent surgery for the cancer of the left colon (sigmoid colectomy or left hemicolectomy), and 215 (46,8 %) patients underwent surgery for rectal cancer. Postoperative complications occurred in 28 (6.1 %) patients, eight of them (1,7 %) needed reintervention (laparotomy) because of anastomotic insufficiency and intraabdominal abscesses. Two (0,4 %) patients died during 30 day postoperative period. CONCLUSION. In our experience, HALS was very reliable andfeasible minimally invasive surgical technique for the cancers of left colon and rectum, related with short learning curve and excellent oncological clearance, short operating time and low number of postoperative complications. It may be used as a standard approachfor this type of pathology, or as a safe bridge from open to conventional laparoscopic surgery.

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The authors declare that there are no conflicts of interest present.