目的    探讨手术机器人行直肠前切除经肛门拖出直肠标本的手术方法。方法    回顾性分析沈阳军区总医院普通外科于2012年7~12月间16例直肠肿瘤病人采用达芬奇手术机器人系统行直肠前切除并经肛门拖出直肠标本的临床资料。结果    16例中男9例，女7 例。13例为直肠癌，2例为直肠绒毛管状腺瘤，1例为直肠神经内分泌瘤。年龄46～84岁，体重指数（BMI）18.8～28.8。均顺利完成手术，手术时间160～610 min，平均（220.4±24.5）min，术中出血量均在50 mL以下，术后排气时间18～74 h，平均（27.3±7.5）h，术后住院时间5～10 d，平均（6.2±2.1）d，每例获取淋巴结2～39枚，平均（18.2±7.6）枚。TNM分期：Ⅰ期2例，Ⅱ期7例，Ⅲ期4例。所有标本切缘均为阴性。所有病例无局部手术并发症。结论    采用达芬奇手术机器人系统切除直肠并经肛门拖出直肠标本的手术方法是安全可行的。

Totally robotic surgery for rectal cancer with transanal specimen extraction        ZHANG Xue-feng, LV Chi, ZHANG Cheng, et al. Department of General Surgery, General Hospital of Shenyang Military Region, Shenyang 110015, China
Corresponding author: LI Jin, E-mail: lvlinger92@gmail.com
Abstract    Objective    To investigate the clinical experience of transanal specimen extraction with robot-sewn anastomosis technique. Methods    The clinical data of 16 cases performed rectal cancer resection by the da Vinci robotic system with transanal specimen extraction and robot-sewn anastomosis technique between July 2012 and December 2012 in General Hospital of Shenyang Military Region were analyzed retrospectively.  Results    There were 9 males and 7 females with age 46-84 years old，and BMI 18.8-28.8 kg/m2. All the cases（13 cases of rectal cancer, 2 cases of rectal villous tubular adenomas, 1 case of rectal carcinoid tumors） were performed robotic surgery successfully without intraoperative conversion．The operative time was 160-610 min [mean (220.4±24.5)min]. The blood loss was below 50mL. The time to first flatus was 18-74 hours [mean (27.3±7.5)hours] postoperatively. The postoperative hospital stay was 5-10 days [mean (6.2±2.1)days]. The number of lymph node harvested from the surgical specimen was 2-39 (mean 18.2±7.6)．TNM stage: 2 cases of stageⅠ, 7 cases of stage II, 4 cases of  stage Ⅲ. All the resection margins were  negative．There was no local surgical complication. Conclusion    Totally robotic surgery for rectal cancer with transanal specimen extraction is safe and feasible.