电子结肠镜引导下腹腔镜治疗结肠息肉的应用体会

Therapeutic laparoscopy guided by electronic colonoscope in treatment of colonic polyp

目的探讨电子结肠镜引导下腹腔镜治疗结肠良恶性息肉的应用价值。方法 45例基底直径≥2.0 cm、位置特殊、操作困难、无法内镜切除的结肠良恶性息肉,在结肠镜引导下行腹腔镜手术治疗。结果 45例均顺利完成手术,其中内镜辅助的腹腔镜小切口切除10例,内镜辅助的腹腔镜楔形切除21例,内镜辅助的腹腔镜经肠腔切除3例,内镜辅助的腹腔镜肠段切除8例,术中冰冻为恶性追加腹腔镜结肠癌根治术3例。无中转开腹,未出现吻合口瘘、梗阻、出血等主要并发症。手术时间平均100(40～220)min,肠功能恢复时间平均3(2～5)d。术后随访平均12(4～24)个月,38例复查肠镜未见息肉残留、复发。结论电子结肠镜引导下腹腔镜联合内镜切除困难的结肠息肉定位准确,切除彻底,对冰冻为恶性的病例可追加结肠癌根治术,是一种治疗结肠良恶性息肉安全、有效的方法。

Objective To discuss the application value of therapeutic laparoscopy guided by electronic colonoscope in treatment of benign and malignant colonic polyp.Methods The therapeutic laparoscopy guided by electronic colonoscope was carried out in 45 cases with the basal body diameter of the colonic polyp ≥ 2.0 cm and the position of the polyp not suitable for endoscopic excision.Results Operations were successful in all the 45 cases.Under endoscopic laparoscope,10 cases received mini incision;20 ones did the wedge excision;3 ones did the excision via enteric cavity and 8 ones did excision of intestinal segment.In 3 cases,the polyp was diagnosed as malignant tumor by frozen section examination and then laparoscopic radical resection of colon carcinoma was carried out.For all the cases,there was no case with conversion to open operation.And there were no complications such as fistula of anastomotic stoma,obstruction and hemorrhage,etc.The average operation time was 100（40-220）min;the average time of intestine functional rehabilitation was 3（2-5）d;the average time of postoperative follow up was 12（4-24）months.In 38 cases which received the examination by enteroscope,residue of polyp and recurrence did not occurred.Conclusion For the colonic polyp that is not suitable for the treatment of endoscopic excision,therapeutic laparoscopy guided by electronic colonoscope can accurately locate the position of tumor and excise it thoroughly.For the malignant polyp diagnosed by the frozen section examination,additional radical resection of colon carcinoma can be carried out,which is a safe and effective method to treat benign and malignant colonic polyp.