腹腔镜直肠癌手术的应用体会

Laparoscopic resection for rectal cancer

目的:探讨腹腔镜直肠癌手术的难度预测、手术要点及并发症的防治。方法:回顾分析98例患者行腹腔镜直肠癌手术的临床资料,总结与手术难度相关的因素。结果:中转开腹15例(15.3%),术后吻合口瘘1例(1.0%),切口感染4例(4.0%),并发粘连性肠梗阻再次开腹分离粘连1例(1.0%),输尿管损伤2例(2.0%),排尿困难3例(3.0%),无围手术期死亡病例。结论:手术难度同瘤体位置、肿瘤长径与坐骨棘间距比(T/I比)相关,T/I比有望成为术前预测腹腔镜手术难度的重要参考指标。Endo-Cutter切断直肠困难为中转开腹的主要原因。

Objective： l.aparoscopic resection for reetal cancer has been considered to be technically difficult. In this study,this laparoscopic teehnique＇s anticipation of difficulty, key point of operation, prevention and treatment of complications were investigated. Methods ： The clinical data of 98 patients who underwent laparoscopie resection of rectal cancer from May 2007 to Dec. 2008 were retrospectively analyzed. The factors correlative to operative difficulty were summarized. Results： Fifteen patients （15.3%） converted to open surgery. Of several postoperative complications, anastomotic leak was found in 1 patient（ 1.0% ） ,infection of incision was found in 4 patients（4.0% ） ,adhesive ileus which needed open lysis in 1 patient（ 1.0% ） ,injury of ureter in 2 patients（2.0% ） ,dysuria in 3 patients（3.0% ）. No death occurred during perioperative period. Conclusions：Operative difficulty is affected by the location of tumor and tumor diameter vs interspinous diameter （T/1 ratio）. T/I ratio is considered to be an important indicator for difficulty of laparoscopy and be instructive in preoperative evaluation. Difficulty in Endo-cutter cutting rectum is the main reason of conversion to laparotomy.