腹腔镜左半结肠癌根治手术的技巧与短期疗效

Surgical skills and short-term outcomes of laparoscope-assisted left hemicolectomy for colon carcinoma

目的探讨腹腔镜左半结肠癌根治术的手术操作技巧与短期疗效。方法回顾性分析2001年8月至2006年7月上海微创外科临床医学中心28例行腹腔镜左半结肠癌根治术患者资料,并探讨其手术操作技巧、术后恢复情况及肿瘤根治性效果。结果Ⅰ期病例1例,Ⅱ期17例,Ⅲ期10例。所有病例无术中严重并发症和手术死亡,3例（10.7%）中转开腹。手术时间为155min,术中平均出血量为100ml,排气时间、进食流质、半流质时间和住院天数分别为3、4、5.5、12d。清扫淋巴结数为11枚,其中结肠上、旁淋巴结4枚,系膜间淋巴结4枚,血管根部淋巴结2枚,手术切除标本长度为14cm。术后吻合口漏2例,肠梗阻1例,肺部感染1例。所有患者均获随访6～55个月,中位随访时间17.5个月。2例发生肝转移,短期累计生存率为92.4%。结论腹腔镜左半结肠切除术治疗左半结肠癌是安全有效的,符合肿瘤根治原则。

Objective To assess the surgical skills and outcomes of laparoscope-assisted left hemicolectomy （LLH） for colon carcinoma. Methods The technique of operation, status of recovery, complications, oncological clearance and of short-term follow-up results were studied on 28 patients who underwent laparoscope-assisted left hemicolectomy for colon cancer from August 2001 to July 2006. Results A total of 15 males and 13 females at age of 30-85 years （mean 58 years） were enrolled in the study. Of all, there was one case at stage Ⅰ, 17 at stage Ⅱ and 10 at stage Ⅲ. No severe complications and death occurred during the operation. Three cases （10.7%） were converted to open surgery. The mean operation time was 155 minutes （70-240 minutes） and the blood loss 100 ml （0-500 ml）. The mean time for passage of flatus,time to liquid diet, semi-liquid diet and hospital stay were 3 days （2-7 days）, 4 days （3-8 days）, 5.5 days （4-9 days） and 12 days （8-54 days） respectively. There were 11 lymph nodes （4-20） including 4 （2-9） from colon and side colon, 4 （1-13） from inter-mesentery and 2 （1-7） from root site of blood vessel. The length of specimen removed was 14 cm （7-29 cm）. Complications were observed in four cases,with two cases （7.1%） of anastmosis leakage, one （3.6%） of pulmonary infection and one （3.6%） of ileus. All the cases were followed up for 6-55 months （average 17.5 months）, as showed the cumulative survival rate of 92.4%. Conclusions Laparoscope-assisted left hemicolectomy for colon cancer is safe and efficient and goes well with. the principle of radical cure of carcinoma.