腹腔镜辅助结肠全（次全）切除术150例

Laparoscopy-assisted total/subtotal colectomy：a report of 150 cases

目的探讨腹腔镜辅助结肠全（次全）切除术（LAC）的技术特点和安全性。方法总结2005年6月至2008年5月问开展的150例LAC手术病例的临床资料。结果本组患者LAC联合改良Duhamel手术治疗重度功能性便秘126例，LAC联合回肠直肠吻合治疗家族性息肉病11例、溃疡性结肠炎8例和结直肠多发肿瘤5例。147例完成LAC,3例中转开腹。腹腔镜下手术时间（76．0±23．5）min，术中出血（35．4±10．9）ml，辅助切口长（5．2±1．1）cm。术后肠道功能恢复时间（42．5±12．6）h，无切口感染、吻合口瘘等并发症。术后1周内．2例出现严重腹泻．2例出现不完全性小肠梗阻，经保守治疗缓解。无并发症者术后住院时间（7．2±1．5）d。116例患者术后获1年以上随访，胃肠生活质量指数为（110．3±20．7）分，与术前的（90．1±23．8）分比较，差异有统计学意义（P〈0．05）。105例重度功能性便秘患者症状均得到缓解；3例结直肠多发肿瘤、5例家族性息肉病和3例溃疡性结肠炎患者均未见复发、转移。结论LAC更好地体现了腹腔镜手术微创的优点．是治疗累及全结肠疾病的合理术式选择。

Objective To summarize the clinical experience and to evaluate the safety and technical characters of laparoscopy-assisted total/subtotal colectomy （LAC）. Methods From June 2005 to May 2008, a total of 150 cases underwent LAC in Jinling Hospital. There were 126 cases of severe functional constipation （SFC） treated by LAC combined with modified Duhamel procedure. There were I l cases of familial adenomatous polyposis, 8 cases of ulcer colitis and 5 cases of multiple colorectal tumors treated with LAC combined with ileum-rectum anastomosis. Results Of the 150 cases, LAC was successfully performed in 147 cases. The mean operation time of LAC was （76.0±23.5） min. The estimated operative blood loss was （35.4±10.9） ml. The length of assisted incision was （5.2±1.1） cm. The time to resume intestinal function was （42.5±12.6） h. There was no postoperative wound infection, anastomotic stoma and other complications. Within 1 week after operation, severe diarrhea occurred in 2 cases and incomplete small bowl obstruction in 2 eases, who were relieved by conservative treatment. The mean postoperative hospital stay in patients without complication was （7.2±1.5） d. One year later, the score of gastrointestinal index quality of life in 116 patients was （110.3±20.7）, which was significantly elevated as compared with the pre-operation score （90.1±23.8） and was not significantly different with the healthy score. The constipation symptoms were released in all the 105 SFC patients with different degree diarrhea in 7 eases and recurrence of mild constipation in 4 eases. There was no sign of recurrence and metastasis in 3 cases of multiple colorectal tumors. Conclusions LAC embodies the advantages of less invasiveness of laparoscopy. It is a reasonable choice of operation method in treating various diseases related to total colon.