腹腔镜辅助左半结肠及乙状结肠切除术手术入路的选择

Surgical Approach Choices of Laparoscopic-assisted Left Colon and Sigmoid Resection

目的探讨腹腔镜辅助左半结肠及乙状结肠切除术手术入路的选择原则及手术方式。方法回顾性研究2006年1月至2011年12月我院普通外科进行的134例腹腔镜辅助左半结肠切除术和乙状结肠切除术的临床资料。左半结肠29例,乙状结肠105例。结果整体平均手术时间为(146.71±30.28)min,术中平均出血量为(65.7±32.3)ml,发生术中并发症5例,发生率为3.73%,并发症发生率最高者为小肠浆膜损伤3例,其次为与气腹有关的皮下气肿2例,术后平均日为(10.54±5.85)d,大体标本的平均长度为(16.76±9.06)cm,肿块平均大小为(15.53±12.81)cm2,经石蜡标本病理检查证实,印戒细胞癌1例腺癌133例其中,按TNM分期,Ⅰ期11例,Ⅱ期64例,Ⅲ期52例,Ⅳ期1例。所有病例均获随访,有1例局部复发,肝转移2例,无肿瘤相关死亡病例。结论在遵循肿瘤手术基本原则的前提下,安全性、方便性、微创性是手术入路选择的目的。

Objective To discuss the selection principle and operation method of laparoscopic-assisted left colon and sigmoid resection. Methods Retrospectively studying clinical data of 134 laparoscopic-assisted left colon and sigmoid resection from January 2006 to December 2011 in general surgery. Left colonic carcinoma 29, sigmoid flexure 105. Results The overall average operating time is （146.71 ± 30.28）min, mean bleeding volum is （65.7 ± 32.3） ml, intraoperative complications is 5, a rate of 3.73 %. The highest of postoperative complications is Intestinal serous damage 3 cases, followed by subcutaneous emphysema 2 cases. The postoperation average day is （ 10.54 ± 5.85） d, The average length of general specimens is （ 16.76± 9.06） cm, mass average size is （15.53 ± 12.81 ）cm2. Paraffin wax specimens pathological examination confirm that Signet-ring cell carcinoma 1 case, adenocarcinoma 133 cases. Stage I 11 cases, stage II64 cases, stage m 52 cases, stage IV 1 cases according to TNM staging. All cases have been followed up, partial recrudescence 1 case, hepatic metastases 2 cases. No tumor related deaths. Conclusion Security, convenience and minimally invasive is the aim of surgical approach choice in the premise of the basic principles of tumor surgery.