基层医院开展腹腔镜下结直肠癌手术的临床应用(附10例报道)

Clinical Application of Laparoscopic Coborectal Operation

目的探讨腹腔镜结直肠手术的临床应用价值。方法分析运用腹腔镜技术,按开放手术原则治疗结直肠癌10例的临床资料,其中右半结肠切除术2例,乙状结肠切除术2例,直肠癌行直肠前切除术(Dixon术)2例,Miles术3例。乙状结肠造瘘术1例。结果 10例手术均成功,1例因直肠中段癌合并肝左叶孤立转移癌,行Dixon术及开腹行肝左叶切除术。平均手术时间215 min,术中平均失血305 ml。术后肠蠕动恢复平均3.4 d,无术后出血、吻合口瘘等并发症。随访6～44月,2例因腹腔内广泛转移,于术后12个月及31个月死亡。1例肝脏转移瘤切除者于术后18个月因肝脓肿死亡,1例Miles术后28个月会阴部软组织种植转移,再次手术局部扩大切除随访12月无异常。结论腹腔镜结直肠手术安全可行,严格掌握手术适应证。

Objective To explore the clinical application value of laparoscopic colorectal operation. Methods analysis of the use of laparoscopic techniques, according to the principle of open operation treatment of 10 cases of colorectal cancer clinical data,where in the right colon resection in 2 cases, the sigmoid colon resection in 2 cases,rectal cancer anterior resection of the rectum （ Dixon ） in 2 cases,Miles in 3 cases. Sigmoid colostomy in 1 case. Results 10 cases of operation were successful, 1 cases with rectal cancer combined with the left lobe of liver isolated metastasis carcinoma, Dixon operation for hepatic resection of the left lobe by laparoscopy. The mean operation time is 215 rain,during the surgery the blood loss is 305 ml. After operation, the intestinal peristalsis recovers to average 3.4 d and left no bleeding and some complications such as fistula. Followed up for 6 - 44 months, 2 eases died due to widespread metastasis in ＂abdomen, one died in 12 months after operation, the other died in 31 months after operation. 1 case died in 18 months after operation as a result of liver metastasis resection. 1 case of Miles perineum soft tissue metastasis in 28 months after operation, the second operation cutting widely,then followed it for 12 months without exception. Conclusion Laparoscopic eolorectal operation is feasible and safe operation, strict control of indications, skilled laparoseopic operation technology and rich experience in open colorectal operation is completed the operation key.