电子肠镜在腹腔镜结直肠切除术中的应用

Application of intraoperative electronic colonoscopy in laparoscopic colorectal surgery: a report of 627 cases

目的探讨电子肠镜在腹腔镜结直肠切除术中的应用价值。方法2001年5月～2006年12月627例患者成功进行了腹腔镜结直肠切除术,94例同时进行术中电子肠镜检查。结果术中电子肠镜检查94例,其中肿块定位13例,术前肠镜不能通过的肿块近端肠管检查80例(74例成功进行,发现近端肠管有小息肉12例均未行活检;直径大于5mm息肉3例,术中快速冷冻活检未见癌;行术中息肉电切术1例,6例因存在不全结肠梗阻导致肠道准备差而失败),术中明确肠吻合口出血1例。无手术死亡,检查后1例出现肠穿孔,3例浆膜撕裂。结论对小肿瘤和术前肠镜不能通过又未进行成功的CT仿真结肠镜检查的患者(右半结肠癌患者除外)实施腹腔镜手术时,需要进行术中电子肠镜检查,以方便小病灶的定位和排除近端多原发癌灶。

[Objective] To investigate the clinical value of intraoperative electronic colonoscopy in laparoscopic colorectal surgery. [Methods] 627 patients, who had laproscopic coleretal surgery were analyzed retrospectively from May 2001 to December 2006. [Results] All cases had preoperative electronic colonoscopy and laparoscopic resection successfully, intraoperative electronic colonoscopy were neccessary in 94 cases, 13 of 94 cases for locating the tumor, 80 of 94 cases for watching the proximal colon which could not been passed during the preoperative colonoscopy （74 cases were successful, 15 cases were found polypi, 3 cases biopsy, 1 case electrosection, 6 cases were unsuccessful because of the poor cleaning degree）, 1 case was defined the bleeding site of anastomodc stoma. No death was reported during operation, 1 colonic perforation and 3 laceration of serous membrane were found. [Conclusion] Intraopoeradve electronic colonoscopy is necessary in locating the small tumor and excluding the multiple colonic cancer of proximal colon which could not been seen in preoperative electronic colonoscopy. colonoscopy; laparoscopy; colorectal surgery