腹腔镜结直肠癌手术的临床分析(附45例报告)

The experience of laparoscopic operation for colorectal cancer:with a report of 45 cases

目的：总结行腹腔镜结直肠癌根治术的临床经验。方法：回顾分析2003年5月至2007年5月45例行腹腔镜结直肠癌根治术患者的临床资料。其中右半结肠癌8例，左半结肠癌5例，乙状结肠癌20例，直肠癌12例。按传统根治术的要求术中使用超声刀或同时用结扎束游离结肠或直肠及其相应的肠系膜和淋巴、脂肪等组织。结肠癌根治术：在腹部左侧或右侧做5cm的辅助切口，腹腔外行肠切除和肠吻合。低位直肠癌行Miles手术者在充分游离乙状结肠和直肠后，在左下腹做辅助性小切口（乙状结肠造口处），切断乙状结肠后，腹部手术组行乙状结肠造口，会阴手术组经会阴行直肠切除术。结果：手助腹腔镜右半结肠癌根治术6例，左半结肠癌根治术3例，乙状结肠癌、直肠中上段癌根治术20例，腹会阴联合直肠切除术6例。腹腔镜手术35例，中转开腹10例，中转率22．2％。无死亡病例。手术时间120～280min，平均180min；出血50～100ml，平均80ml。术后随访6～36个月，平均18个月。8例肿瘤复发、转移死亡，复发率22．9％。未发现腹壁小切口和穿刺孔转移。结论：依据结直肠肿瘤分期和部位选择合适的病例，用腹腔镜完成微创手术安全可行，可以达到根治目的。

Objective：To summarize the experience of laparoscopic colorectal cancer operation. Methods：The clinical data of 45 performed laparoscopic colorectal cancer operations from May 2003 to May 2007 were retrospectively analyzed. Among these cases, there were 8 cases of right colonic cancer,5 cases of left colonic cancer,20 cases of sigmnoid colonic cancer and 12 cases of rectal cancer. According to the principle of traditional radical operation, ultrasound knife was used to dissociate colorectum and its mesentery for patients with colonic cancer,5cm assisted incision was made on left or right quadrant,enterectomy and intestinal anastomosis were performed out of abdominal cavity. For patients with Miles operations for low rectal cancer, assisted incision was performed on left lower quadrant after dissociation of sigmoid colon and rectum. Sigmoidostomy and rectectomy were perfomed simultaneously. Results：There were 6 cases in right hemicolectomy,3 cases in left hemicolectomy,20 cases in sigmoid colorectomy and 6 cases in Miles. 35 cases underwent laparoscopic operation successfully and 10 cases were converted to laparotomy. No death cases occurred. The operative time ranged from 120 to 280min（ mean 180min）. The blood loss was from 50 to 100ml（ mean 80ml）. All cases were followed up from 6 to 36 months（ mean 18 months）. 8 patients died by recurence and metastasis of tumor. No metastasis of abdominal incision and sites of puncture occurred. Conclusions： Laparoscopic colorectal cancer operation is safe and feasible for suitable cases based on the stage and location of tumor,and can achieve radical effect.