腹腔镜辅助下全结直肠切除术10例报告

Laparoscopic-assisted Total Colorectal Resection:Report of 10 Cases

目的探讨腹腔镜辅助下全结直肠切除术的可行性、安全性。方法 2008年10月～2011年10月行腹腔镜辅助下全结肠切除术10例,其中家族性腺瘤性息肉病4例,息肉癌变2例,结直肠多发癌1例,慢性溃疡性结直肠炎3例。建立气腹后,超声刀游离病变肠管系膜,并用可吸收夹夹闭主要血管后,Endo-GIA离断直肠下端,辅助切口4～6 cm,取出切除标本,用管形吻合器行直肠-回肠吻合。结果 10例腹腔镜辅助下全结直肠切除术均获成功,手术时间(364±37)min,术中出血量(200±59)ml,术后胃肠功能恢复时间(68±18)h,住院时间14～20 d。术后无腹腔出血、内脏器官损伤等并发症。10例随访6～36个月,大便3～13次/d,3例结、直肠癌无肿瘤复发、转移。结论在熟练掌握腹腔镜结直肠部分切除术前提下,腹腔镜辅助下全结直肠切除术是安全、可行的。

Objective To investigate the feasibility and safety of laparoscopic-assisted total colorectal resection. Methods The clinical data of 10 patients, who underwent laparoscopic-assisted total colorectal resection in our hospital from October 2008 to October 2011, were reviewed. Among the cases, four patients had familial adenomatous polyposis, two had polyp with carcinomatous transformation, one showed multiple colorectal cancers, and three had chronic ulcerative colitis. After establishing pneumoperitoneum, with a ultrasound scalpel, we separated the effected intestinal mesentery, and then closed the major vessels with absorbable clips so that to resect the lower part of the rectum with Endo-GIA. The specimen was then removed through a 4- to 6-cm auxiliary incision. Finally rectum-ileum anastomosis was made with a tubular stapler. Results The procedure was completed successfully within （364 -＋ 37）min,the intraoperative blood loss was （200 -＋ 59 ）ml, postoperative recovery time of gastrointestinal function was （68 ＋ 18） h, and operative hospital stay was 14 -20 d. No patients had intraabdominal hemorrhage or visceral organ injurey. The patients were followed up for 6 to 36 months, during which their defecation frequency was 3 - 13 times/d. None of the 3 cases of colorectal cancer showed recurrent or metastatic tumors. Conclusion Laparoscopic-assisted total colorectal resection is feasible and safe, providing the doctors are familiar with the procedure of laparoscopic subtotal colorectal resection.