中间入路法腹腔镜辅助全结直肠切除的临床应用

Clinical application of laparoscopy-assisted total proctocolectomy using medial-to-lateral approach

目的探讨中间入路法腹腔镜辅助全结直肠切除的安全性及可行性。方法回顾性分析2005年10月至2012年1月间在南方医科大学附属南方医院普通外科接受中间入路法腹腔镜辅助全结直肠切除术的21例患者的临床资料。结果除1例（4．8％）因腹腔内严重粘连而中转开腹外．余20例患者顺利完成腹腔镜手术。手术时间（237．1±64．2）rain，术中出血量（90．0±77．7）ml，术后排气时间（2．7±0．8）d，术后住院时间（11．8±5．7）d。术后并发症3例（14．3％），其中吻合口瘘、淋巴漏和吻合口狭窄各1例。随访时间4～60（中位22）个月，死亡2例，其中1例于术后5个月死于肿瘤进展．1例死于多器官衰竭。结论应用中间入路法行腹腔镜辅助全结直肠切除可简化手术步骤、维持外科层面、缩短手术时间，在腹腔镜结直肠手术经验较为丰富的单位开展是安全可行的。

Objective To investigate the safety and feasibility of laparoscopy-assisted total proctocolectomy using medial-to-lateral approach. Methods Between October 2005 and January 2012, 21 consecutive patients underwent laparoscopic-assisted total proctocolectomy by medial-to-lateral approach in Department of General Surgery in Nanfang Hospital. The clinical data and follow-up results were reviewed. Results Twenty cases underwent laparoscopic resection successfully, and 1 case（4.8%） was converted to open surgery because of serious peritoneal cavity adhesion. The mean operative time was （237.1±64.2） min and intraoperative blood loss was （90.0±77.7） ml. The mean time to first flatus was （2.7±0.8） days. The mean postoperative hospital stay was （11.8±5.7） days. Three patients （ 14.3% ） experienced postoperative complications, including anastomotic leakage （n=l）, lymphatic leakage （n=l）, and anastomotic stricture （n=1）. The median follow-up was 22 months （4-60 months）. There were two deaths including one patient died of progressive disease 5 months after surgery and the other died of multiple organ failure. Conclusions The advantages of laparoscopy-assisted total proctocolectomy using medial-to-lateral approach include simplified surgical procedure, clearly revealed surgical plane, and shortened operative time. This procedure is safe and feasible in the experienced department of laparoscopic colorectal surgery.