运用腹腔镜技术根治性切除直肠恶性肿瘤的临床应用研究

A clinical study in laparoscopic radical resection of rectal cancer

目的探讨运用腹腔镜外科技术根治性切除直肠恶性肿瘤的可行性与临床意义。方法回顾性分析运用腹腔镜技术根治性切除57例直肠肿瘤的手术方式与临床资料,其中高位直肠癌8例,中位直肠癌19例,低位直肠癌21例,肛管癌9例。结果55例在全腹腔镜或其辅助下完成根治性切除术,2例中转开腹手术;手术时间平均(136±25)min,平均出血量(85±38)mL;术后无伤口感染、腹腔出血、吻合口漏、狭窄;术后病理组织学检查,肿瘤标本切除长度(26.35±13.26)cm,切除淋巴结数目(12.35±9.67)个;随访4￣36个月,2例术后14个月、18个月腹腔广泛转移死亡。结论运用腹腔镜外科技术根治性切除直肠癌具有创伤小、恢复快,且在理论和技术上是安全可行的,近期疗效可,值得推广。

[Objective] To study the feasibility and clinical significance of using laparoseopic radical resection in rectal malignant tumor. [Methods] Retrospective study was used to analyze fifty-seven cases with rectal cancer who underwent laparoscopic radical resection from 2001 to 2004. Of them, eight patients with high rectal cancer, nineteen patients with middle rectal cancer, twenty-one patients with low rectal cancer and nine patients with anal canal cancer. [Results] Fifty-five cases were successfully done laparoseopically or laparoscopically-assisted, two cases converted to laparotomy. The average operating time was （136±25） rain and the mean operative blood less was （85± 38） mL. There was no wound infection, abdominal hemorrhage, anastomotic leakage and anastomotic stenosis after operation; pathological examination after operation, resection length of tumor specimen was （26.35±13.26） cm, number of lymph nodes excised was （12.35±9.67）. Follow-up for 4-36 months, two cases died from extensive metastasization in abdominal cavity in fourteen and eighteen months postoperative. [Conclusions] Laparoseopic radical resection of rectal cancer has smaller incision, less compicalions, quick recovery. It is safe and reliable. The initial postoperative effect is available, worthy of recommending.