肿瘤近侧肠管精准切除在新辅助治疗后腹腔镜直肠前切除术中的应用OA

Objective:To compare with conventional extended proximal resection and investigate the safety and clinical benefits of precise proximal resection based on endoscopic ultrasonography(EUS)status assessment and localization of intestinal tract in laparo-scopic anterior rectal resection after neoadjuvant therapy.Methods:Clinical data of 95 patients who underwent laparoscopic anterior re-section following neoadjuvant therapy between Jan.2021 and Jun.2024 were retrospectively analyzed.Among them,45 patients received conventional extended proximal resection(extended group),and 50 patients underwent preoperative EUS to evaluate the tumor regres-sion and the proximal intestinal wall thickness of the tumor.The obvious boundary of intestinal wall thickness was marked with carbon nanoparticle suspension as the lowest position for intestinal tract resection(precise group).All EUS examinations were performed by experienced endoscopists,and all operations were conducted by the same surgical team with standard laparoscopic anterior rectal resec-tion.Baseline characteristics,intraoperative parameters,pathological findings,and postoperative recovery were compared between the two groups.Results:The proportion of splenic flexure mobilization in the precise group was significantly lower than that in the extended group(28%vs.100%,P<0.001).The operative time[(253.88±58.51)min vs.(276.33±32.21)min,P=0.025]and the length of proximal intestinal tract resection[(11.28±2.59)cm vs.(15.88±3.50)cm,P<0.001]in the precise group were shorter than those in the extended group.No significant differences were found in the number of harvested lymph nodes,intraoperative blood loss and postoperative pathological stage.The incidence of anastomotic leakage was comparable(6.0%vs.6.7%,P>0.999).All patients with a defunctioning stoma underwent stoma reversal within 6 months after surgery,and no complications such as anastomotic disruption and tubular stenosis of the proximal intestinal tract at the anastomasis that affected stoma reversal occurred.Conclusions:EUS-guided preci-sion proximal resection allows accurate localization and excision of irradiation-induced edematous bowel proximal to the tumor.Compared with conventional extended proximal resection,it reduces the need for splenic flexure mobilization and shortens operative time,while maintaining comparable anastomosis-related complications.This technique is worthy of clinical promotion.