Objective: To report the perioperative management and robot-assisted minimally invasive surgery results of one case with malignant tumor of anal canal combined with severe abdominal distention. Methods: A 66-year-old male suffer from adenocarcinoma of anal canal (T3N0M0) with megacolon, megabladder and scoliosis. The extreme distention of the colon and bladder result in severe abdominal distention. The left diaphragm moved up markedly and the heart was moved to the right side of the thoracic cavity. Moreover, there was also anal stenosis with incomplete intestinal obstruction. Preoperative preparation: fluid diet, intravenous nutrition and repeated enema to void feces and gas in the large intestine 1 week before operation. Foley catheter was placed three days before surgery and irrigated with saline. After relief of abdominal distention, robotic-assisted abdominoperineal resection+ subtotal colectomy+colostomy was performed. Results: Water intake within 6 hours post-operatively; ambulance on Day 1; anal passage of gas on Day 2; semi-fluid diet on Day 3; safely discharged on Day 6. Conclusion: Robotic-assisted minimally invasive surgery is safe and feasible for patients with malignant tumor of anal canal combined with severe abdominal distention after appropriate and effective preoperative preparation to relieve abdominal distention.目的： 报告本中心1例肛管恶性肿瘤合并巨腹征经围手术期处理及机器人辅助微创手术结果。 方法： 患者男性，66岁，肛管腺癌（T3N0M0）合并巨结肠、巨膀胱、脊柱侧弯。因结肠和膀胱极度扩张导致巨腹征，左侧膈肌明显上移心脏被推移至胸腔右侧，肛管狭窄合并不全肠梗阻表现。术前准备：术前1周无渣饮食，静脉营养，反复多次灌肠，排出大肠内积存粪便和气体。术前3 d置导尿管，生理盐水冲洗膀胱；巨腹征得到明显缓解后，在机器人辅助下行腹会阴联合直肠癌根治术+结肠次全切除术+结肠造口术。 结果： 患者术后6 h饮水，24 h下床活动，48 h内排气，术后第3天半流质饮食，第6天顺利出院。 结论： 肛管恶性肿瘤合并巨腹征患者，经过精准有效的术前准备，巨腹征缓解后，在机器人辅助下施行微创手术是安全可行的。.
Objective: To investigate the feasibility and safety of a robotic surgical system (or laparoscopy) in combination with colonoscopy (combined) for the treatment of stage T1N0M0 colorectal cancer. Methods: This was a descriptive case series. Indications for combined dual-scope surgery in this study were as follows: (1) preoperative colonoscopic examination of lesions in the middle and upper rectum and colon with pathologically confirmed high-grade intraepithelial neoplasia, intramucosal adenocarcinoma, or adenocarcinoma; (2) no distant or local lymph node metastases; and (3) endoscopic ultrasound and magnetic resonance imaging evidence of tumor invasion of the mucosal or submucosal, but not the muscular, layer (i.e., T1). The clinical data of 13 patients with stage T1 colorectal cancer who had undergone dual-scope combined resection using a robotic surgery system or laparoscope-assisted combined colonoscopy surgery at the First Affiliated Hospital of Zhengzhou University from April to October 2022 were retrospectively collected, including 6 males and 7 females, with a median age of 59 (48~88) years old. The tumors were located in the upper and middle rectum in six patients, in the sigmoid colon in three, and in the ascending colon in four. The median maximum diameter of the tumors was 3.0 (1.8-5.0) cm. The surgery was performed by a robotic surgery system (or laparoscopy) with peritumoral D1 lymph node dissection at the first station in the tumor area. The tumors were resected under direct vision and the defects in the intestinal wall were using a robotic surgery system (or laparoscopy). A robotic surgery system was combined with colonoscopy in eight cases and laparoscopy combined with colonoscopy in the remaining five. Studied variables includes surgical and pathological features, postoperative factors, and outcomes. Results: Surgery was successful in all 13 patients with no need for conversion to open surgery or intraoperative blood transfusion. The median operating time was 85 (60-120) minutes, median intraoperative bleeding 3 (2-5) mL, median number of lymph nodes harvested 3 (1-5), and the median circumferential resection margin 0.8 (0.5-1.0) cm. Postoperative pathological examination showed lymph node metastasis in one patient, who therefore underwent additional radical surgery. The median postoperative time to ambulation was 1 (1-2) days. The urinary catheters of all patients were removed 1 day after surgery and the median length of stay was 4 (3-5) days. No abdominal infection, anastomotic leakage or bleeding occurred in any of the study patients. The median follow-up time was 10 (6-12) months, during which no tumor recurrence or metastasis was found, and the quality of life was satisfactory. Conclusions: The combination of two minimally invasive platforms, a robotic surgery system (or laparoscopy) and colonoscopy, is safe and feasible for resection of stage T1 colorectal cancer and has a good short-term prognosis.目的： 探讨机器人手术系统（或腹腔镜）联合结肠镜（双镜联合）治疗T1期（T1N0M0）结直肠癌的可行性及安全性。 方法： 采用描述性病例系列研究的方法。本研究中双镜联合手术适应证：（1）术前经肠镜检查病变部位为直肠中上段以及结肠，病理证实为高级别上皮内瘤变、黏膜内腺癌或腺癌；（2）无远处转移以及局部淋巴结转移；（3）内镜超声及MRI提示肿瘤侵犯深度为黏膜或黏膜下层即T1，未侵及肌层。回顾性收集2022年4—10月期间，在郑州大学第一附属医院应用机器人手术系统或腹腔镜辅助联合结肠镜行双镜联合切除术治疗的13例T1期结直肠癌患者的临床资料。其中男性6例，女性7例，中位年龄59（48~88）岁；肿瘤位于直肠中上段6例，乙状结肠3例，升结肠4例；肿瘤最大径中位数3.0（1.8~5.0）cm；手术方法为机器人手术系统（或腹腔镜）下行肿瘤区域肠壁裸化及第一站淋巴结清扫；结肠镜肠腔内直视下全层切除肿瘤；利用机器人手术系统（或腹腔镜）协助肿瘤切除并修复肠壁缺损。机器人手术系统联合结肠镜手术8例，腹腔镜联合结肠镜手术5例。观察手术情况、围手术期情况和术后病理以及随访情况。 结果： 13例患者手术均顺利完成，无中转开腹或术中输血。中位手术时间85（60~120）min，中位术中出血量3（2~5）ml，淋巴结清扫中位数3（1~5）枚，肿瘤环周切缘中位距离0.8（0.5~1.0）cm；其中1例术后病理示淋巴结转移，予以追加根治性手术。全组患者术后中位排气时间1（1~2）d，均在术后1 d拔除尿管并下床活动，中位住院时间4（3~5）d。全组均未出现腹腔感染、吻合口漏及出血。全组患者中位随访时间10（6~12）个月，均未发现肿瘤复发及转移，生活质量满意。 结论： 机器人手术系统（或腹腔镜）与结肠镜两种微创平台优势互补，联合进行T1期结直肠癌切除手术安全可行，且术后短期预后良好。.
Intestinal adaptation is a spontaneous compensation of the remanent bowel after extensive enterectomy, which improves the absorption capacity of the remanent bowel to energy, fluid and other nutrients. Intestinal adaptation mainly occurs within 2 years after enterectomy, including morphological changes, hyperfunction and hyperphagia. Intestinal adaptation is the key factor for patients with short bowel syndrome to weaning off parenteral nutrition dependence and mainly influenced by length of remanent bowel, type of surgery and colon continuity. In addition, multiple factors including enteral feeding, glucagon-like peptide 2 (GLP-2), growth hormone, gut microbiota and its metabolites regulate intestinal adaptation via multi-biological pathways, such as proliferation and differentiation of stem cell, apoptosis, angiogenesis, nutrients transport related protein expression, gut endocrine etc. Phase III clinical trials have verified the safety and efficacy of teduglutide (long-acting GLP-2) and somatropin (recombinant human growth hormone) in improving intestinal adaptation, and both have been approved for clinical use. We aim to review the current knowledge about characteristics, mechanism, evaluation methods, key factors, clinical strategies of intestinal adaptation.广泛肠切除术后，残余肠道出现自发性代偿性改变，以此来增加能量、液体和营养要素的吸收能力被称为“肠道适应”现象。这主要发生在肠切除术后2年内，表现为残余肠道的形态改变、功能亢进及患者的行为学变化。肠道适应的程度是短肠综合征患者能否摆脱肠外营养依赖的关键，这主要与残余肠道长度、手术解剖类型和是否保留结肠连续性有关。此外，肠腔内营养物质刺激、胰高血糖素样肽-2（GLP-2）、生长激素、肠道菌群及其代谢产物等因素可通过多种途径调控肠道适应，如干细胞增殖与分化、细胞凋亡、血管生成、营养物质转运相关蛋白表达和肠道内分泌功能等。三期临床试验已经验证了Teduglutide（长效GLP-2）和Somatropin（重组人生长激素）用于改善肠道适应的安全性和有效性，并获批应用于临床。本文旨在梳理肠道适应特征、发生机制、评估方法、影响因素和临床策略等方面的研究进展。.
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