腹腔镜结直肠肿瘤手术18例报道

Laparoscopic Resection for Colorectal Neoplasms (Report of 18 Cases )

目的探讨腹腔镜结直肠肿瘤手术的安全性、有效性、手术方法及其应用价值。方法回顾性分析我院2007年6月至2008年3月期间18例结直肠肿瘤患者施行腹腔镜手术的临床资料和经验。结果本组中直肠癌5例,乙状结肠癌6例,乙状结肠息肉2例,降结肠癌和升结肠癌各2例,升结肠脂肪瘤1例。共15例手术顺利完成,其中施行Dixon手术4例,Miles手术1例,乙状结肠根治性切除5例,乙状结肠部分切除2例,左半结肠切除2例,右半结肠切除1例;3例患者因肥胖或肿瘤侵犯邻近器官而中转开腹手术,术中平均失血量约为110ml,平均清扫恶性肿瘤淋巴结数目13.5枚,术后肠功能恢复时间平均40h,平均住院时间9d,无手术死亡病例,无术后出血、吻合口漏等并发症。结论腹腔镜结直肠肿瘤手术具有创伤小、术后恢复快等优点,只要能严格把握适应证和熟练掌握腹腔镜技术,腹腔镜结直肠肿瘤手术安全、有效,具较好的应用前景。

Objective To explore the safety, effectiveness, operation mode and clinical value of the laparo-scopic coloreetal resection. Methods The clinical data and experiences of laparoscopic resection for 18 cases with colorectal neoplasm from Jun. 2007 to Mar. 2008 were studied retrospectively. Results Among 18 cases, there were 5 cases of rectal cancer, 6 cases of sigmoid colon carcinoma, 2 cases of sigmoid colonic polyp, 2 cases of descending colon carcinoma, 2 cases of ascending colon carcinoma and 1 case of ascending colonic lipoma. Fifteen cases of laparoscopic colorectal resection were performed successfully, including Dixon procedure 4 cases, Miles operation 1 case, radical resection of sigmoid colon 5 cases, palliative resection of sigmoid colon 2 cases, left hemicolectomy 2 cases and right hemicolectomy 1 case. Three cases converted to laparotomy due to adiposity or advanced status of local disease. Average intraoperative blood loss was 110 ml. The average number of lymph nodes dissected was 13.5. It took about 40 hours to restore intestinal function. The average time of hospitalization was 9 days. No one died during operation and no complications such as anastomotic leakage and postoperative hemorrhage occurred. Conclusion Laparoseopie resection for colorectal neoplasms possesses less trauma and rapid postoperative recovery. Laparoscopic colorectal surgery is safe and effective with skill and indication.