摘要目的:评价橡皮圈牵引应用于超级微创手术（SMIS）的切除和创面封闭及治疗直径≥15 mm的结直肠较大病变的有效性和安全性，总结手术技巧。方法:回顾性分析2022年2月至2023年11月在解放军总医院第一医学中心行SMIS的结直肠病变患者的临床资料，共收集24例应用橡皮圈牵引技术的病例，其中辅助切除组21例，创面封闭组3例。记录病变的基本信息、切除时长、切除速度、手术切缘情况、术中和术后并发症等指标；分析并归纳橡皮圈牵引应用于结直肠侧向发育型肿瘤或粗蒂息肉的SMIS切除病变及创面封闭时的手术技巧。结果:辅助切除组21例患者手术切除标本的中位面积为5.89（3.14，8.93） cm 2。切除时间为（81.2 ± 34.2） min，切除速度为（0.112 8 ± 0.057 3）cm 2/min，17例（81.0%，17/21）水平切缘阴性，19例（90.5%，19/21）垂直切缘阴性；2例术中固有肌层暴露且未发生固有肌层损伤，1例内镜治疗不佳转外科手术，1例发生术后穿孔转外科修补，所有病例均未见术后出血。创面封闭组3例患者术后均无不良事件发生。 结论:橡皮圈牵引在结直肠较大病变的SMIS切除和创面封闭临床应用中有良好的安全性和有效性。

abstractsObjective:To evaluate the effectiveness and safety of rubber band traction in the resection and defect closure of super minimally invasive surgery (SMIS) for the treatment of large colorectal lesions with a diameter ≥ 15 mm, and to summarize the application and surgical techniques of rubber band traction in SMIS of large colorectal lesions.Methods:The clinical data of patients with colorectal lesions who underwent SMIS in the First Medical Center of the Chinese PLA General Hospital from February 2022 to November 2023 were retrospectively analyzed, a total of 24 cases applying rubber band traction technique were collected, including 21 cases in the assisted resection group and 3 cases in the defect closure group. Basic information of the lesions, resection duration, resection speed, surgical margins, intraoperative and postoperative complications, and other indicators were recorded. The surgical techniques of rubber band traction applied to the resection as well as defect closure of SMIS in patients with colorectal laterally spreading tumors or sessile polyps were analyzed and summarized.Results:A total of 21 patients who received rubber band traction-assisted SMIS resection were included in the study. The median area of the surgical resection specimen was 5.89 (3.14, 8.93) cm 2, the resection duration was (81.2 ± 34.2) min, and the resection speed was (0.112 8 ± 0.057 3) cm 2/min. Seventeen cases (81.0%, 17/21) had negative horizontal resection margins, and 19 cases (90.5%, 19/21) had negative vertical resection margins. Two cases had intraoperative exposure of the muscularis propria without muscularis propria injury. One case was referred to surgery because of the poor endoscopic treatment efficacy. No postoperative bleeding occurred in any case. A total of 3 cases of rubber band traction-assisted defect closure were included with no postoperative adverse events. Conclusions:The clinical application of rubber band traction in the SMIS and defect closure of large colorectal lesions have good safety and effectiveness.