腹腔镜结、直肠癌切除术的临床分析

Clinical analysis of laparoscopic colorectal cancer resection

目的:总结腹腔镜结直肠癌切除术在临床应用过程中的经验与体会。方法:对96例结直肠癌手术进行分组,腹腔镜组48例和开腹组48例,手术方式包括:Dixon手术37例,Miles手术20例,乙状结肠切除14例,横结肠切除14例,右半结肠切除11例。结果:腹腔镜组:手术时间平均(180±58.5)min。术后平均(1.5±1)d下床活动,平均(3±0.5)d进流质饮食,术后平均住院(10±2.5)d,无围手术期死亡病例。开腹组:手术时间平均(180±30.0)min。术后平均(3±1)d下床活动,平均(4±0.5)d进流质饮食,术后平均住院(15±2.5)d,无围手术期死亡病例。术中术后并发症:腹腔镜组:术中大出血2例,术后吻合口瘘1例,吻合口出血2例,切口感染2例,无切口疝、腹内疝、肠梗阻。总体并发症发生率14.6%。开腹组:术中大出血1例,术后吻合口瘘2例,吻合口出血1例,切口感染2例,切口疝1例,肠梗阻1例,无腹内疝,总体并发症发生率16.7%。结论:腹腔镜结直肠癌切除手术安全可行,具有创伤较小、术后疼痛程度轻及术后恢复快等优点。腹腔镜下良好的显露,熟练细致的解剖操作是手术成败的关键。

Objective To summarize the experience and understanding in clinical application of laparoscopic colorectal cancer resection.Method Total 96 cases of colorectal cancer underwent operation were divided into the laparoscopic surgery group and the laparotomy group.The surgery methods included 37 cases by Dixon surgery,20 cases by Miles surgery,14 cases accepted sigmoid resection,transverse colon resection and right colon resection in 14 cases and 11 cases,respectively.Results The laparoscopic surgery group： The average operative time was（180 ± 58.5） min,the average time of getting off bed after surgery was（1.5 ± 1） d,the average time of taking liquid diet was （3 ±0.5） d,the average postoperative hospital stay was （10 ±2.5） d.No perioperative deaths occured.The laparotomy group： The average operative time was （180 ± 30.0） min,the average time of getting off bed after surgery was （3 ± 1） d,the average time of taking liquid diet was （4 ± 0.5） d,the average postoperative hospital stay was（15 ± 2.5） d.No perioperative deaths occured.Intraoperative and postoperative complications： The laparoscopic surgery group： 2 cases of massive hemorrhage during operatrion,1 case of postoperative anastomotic leakage,2 cases of anastomotic bleeding,2 cases of incisional infection.No incisional hernia,abdominal hernia and intestinal obstruction occured.The overall complication rate was 14.6%.The laparotomy group： 1 case of massive hemorrhage during operation,2 cases of postoperative anastomotic leakage,1 case of anastomotic bleeding,2 cases of incisional infection,1 case of incisional hernia,1 case of intestinal obstruction.No abdominal hernia occured.The overall complication rate was 16.7% .Conclusion Laparoscopic colorectal cancer resection is feasible and safe,with the advantages of less trauma,less postoperative pain,rapid postoperative recovery,and so on.Good reveal under laparoscope,skilled and meticulous anatomy operation are the keys to success.