中间入路腹腔镜辅助结肠切除术150例临床分析

Laparoscopy-assisted colectomy with a medial-to-lateral approach:Clinical analysis of 150 cases

目的探讨腹腔镜辅助中间入路结肠切除手术的可行性及手术技巧。方法回顾性研究2004年1月～2007年6月我院微创外科进行的150例腹腔镜辅助下各类结肠切除术的临床资料。其中,右半结肠99例,左半结肠19例,乙状结肠32例。结果整体平均手术时间为(130.8±51.8)min,术中平均出血量为(85.7±109.8)ml,无重大术中并发症发生。共发生术后并发症17例,发生率为11.33%。并发症发生率最高者为吻合口漏12例,其次为吻合口出血3例,切口感染2例,肠梗阻和深静脉感染1例。病人平均住院天数为(14.56±10.44)d。大体标本的平均长度为(17.67±8.24)cm,肿块平均大小为(14.86±12.21)cm2。经石蜡标本病理检查证实,除6例为绒毛管状腺瘤、1例为类癌、1例为错构瘤外,余142例均为腺癌。其中,按TNM分期,I期46例,II期50例,III期46例。所有病例均获随访。有1例局部复发、无远处转移的病例。无肿瘤相关死亡病例。结论腹腔镜辅助下结肠切除手术可选择中间入路完成。但采用该手术径路是否能达到与传统手术相同的肿瘤根治性仍有待进一步验证。

Objective To assess the feasibility and technique of laparoscopy-assisted colectomy with a medial-to-lateral approach. Methods From January 2004 to June 2007,150 patients underwent laparoscopy-assisted colectomies with a medial-to-lateral approach. Among them, 99 were subjected to right hemicolectomies, 19 to left hemicolectomies, and 32 to sigmoidectomies, respectively. Their demographics, operative technique ＆ proficiency, clinical outcome including hospital stay（days）, morbidity and mortality were recorded and analyzed. Results No cases were converted to open surgery. The mean operative time was（130. 8 ± 51. 8）min and the blood loss was（85. 7 ± 109. 8）ml. No major intraoperative complication was observed. The mean time of postoperative hospital stay was（14. 56 ± 10. 44） days. The overall morbidity rate was 11.33% （17 cases）, of which there were 12 cases of anastomotic leakage and 3 cases of anastomotic hemorrhage. The mean length of specimen was（ 17. 67 ± 8. 24）cm and the mean size of tumor was（ 14. 86 ± 12. 21）cm^2. The pathological examination revealed all of the specimens were adenocarcinomas except 6 villous adenomas, 1 carcinoid and 1 harmatoma. Forty-six, 50 and 46 patients were categorized into stage Ⅰ, Ⅱ, Ⅲ according to the TNM pathological staging respectively. There was one cases of recurrence but no metastasis. Conclusion Laparoscopy-assisted colectomy with a medial-to-lateral approach can be successfully performed, but the oncological result is still undefined.