腹腔镜直肠癌根治术80例临床分析

Laparoscopic Radical Resection of Rectal Carcinoma:Report of 80 Cases

目的探讨腹腔镜直肠癌根治术的可行性和安全性。方法2004年3月～2008年1月,施行腹腔镜直肠癌根治术80例。遵循肿瘤根治原则,切除肿瘤两端足够的肠管及相应的系膜并清扫淋巴脂肪组织,直肠低位前切除(Dixon)术在腹腔镜下完成吻合术,Miles术行乙状结肠造口。结果中转开腹4例,其余76例均完成腹腔镜手术。其中Dixon术44例,手术时间(178±38)min,术中出血(61±17)ml,切除淋巴结数(11.3±2.9)枚,术后住院时间(7.1±3.2)d;Miles术32例,手术时间(231±49)min,术中出血(210±178)ml,切除淋巴结数(12.9±3.7)枚,术后住院时间(9.3±4.1)d。所有标本远近切缘无癌残留。术后人工造口狭窄1例,会阴部切口积液5例,吻合口漏1例,早期排尿困难6例。无术后出血、手术死亡等并发症。70例随访9～48个月,5例肿瘤复发,2例术后死于肿瘤多处转移造成脏器功能衰竭,粘连性肠梗阻5例。结论在严格掌握适应证和丰富的开腹大肠癌手术经验和熟练的腹腔镜手术技术的基础上,腹腔镜直肠肿瘤根治手术是安全可行的。

Objective To investigate the feasibility and safety of laparoscopic radical resection for rectal carcinoma. Methods A total of 80 patients with rectal carcinoma received laparoseopic radical resection in our hospital from March 2004 to January 2008. During the operation, adequate proximal and distal bowel segments, and mesentery and lymph nodes surrounding the tumor were resected completely. And then lower anterior resection （Dixon） and sigmoid colostomy for abdominal perineal resection （Miles） were implemented. Results Among the 80 patients, 4 were converted to open surgery during the operation, and the other 76 patients were treated by laparoscopy successfully. Dixon surgery was performed on 44 cases with a mean operation time of （ 178 ± 38 ） minutes, intraoperative blood loss of （61 ± 17 ） ml, excised lymph nodes number of （11.3± 2.9 ） , and postoperative hospital stay of （7.1 ±3.2） days. Miles were carried out on 32 patients, in which the mean operation time was （231 ±49） minutes and intraoperative blood loss was （210 ±178） ml; a mean of （12.9± 3.7） lymph nodes were resected, the postoperative hospital stay was （9. 3 ±4. 1 ） days. No residual cancer was found in the patients. After the treatment, 1 patient developed stoma stenosis, 5 showed perineal wound infection, 1 had anastomotic leak, and 6 complained of urinary retention immediately after the surgery. No patient had postoperative hemorrhage or died after the procedure. Follow-up was achieved in 70 cases for 9 to 48 months, during which 5 patients had recurrence, 2 died of multiple organ failure induced by multiple metastasis, and 5 patients developed ileus. Conclusion Laparoscopic resection for rectal carcinoma is safe and feasible for selected patients, when the surgeons are skilled with experience on both open colectomy and laparoscopic surgery .