腹腔镜结直肠癌手术48例临床分析

Clinical analysis of laparoscopic colorectal-carcinoma surgery in 48 cases

目的:探讨腹腔镜结直肠癌根治术的手术方法及临床效果。方法:运用腹腔镜技术,按开放手术原则治疗结直肠癌48例,其中右半结肠切除术5例,左半结肠切除术2例,乙状结肠切除术4例;直肠癌行直肠前切除术20例,行腹会阴联合直肠切除术17例。结果:48例中1例因直肠上段癌侵及输尿管中转开腹完成手术;1例右半结肠癌术后反复便血,第3天再手术发现吻合口出血给予缝扎止血;术后均康复出院。手术时间100～190 min;术中出血量40～250 ml。术后1～4 d肠蠕动恢复。无术后吻合口漏、尿潴留等并发症。术后住院7～12 d。46例随访1～27个月,1例8个月腹腔内广泛转移;另有2例出院后6个月内因粘连性肠梗阻再次住院保守治疗后恢复。结论:腹腔镜结直肠癌手术安全,创伤轻、痛苦少,康复快。医生熟练的腹腔镜技术和丰富的开腹结直肠手术经验是手术成功的关键。

Objective： To explore the surgical method and clinical effect of laparoscopic colorectal-carcinoma surgery.Methods： Fourty-eight cases with colorectal cancer were treated with laparoscopic technique according to the principle of open operation,which included right colon resection in 5 cases,left colon resection in 2 cases,sigmoid colon resection in 4 cases,rectal anterior resection in 20 cases and perineum combined with rectum resection in 17 cases.Results： In 48 cases,1 case with upper rectal carcinoma invasing ureter was converted to open operation.Postoperative recurrent hemafecia in 1 case treated with right colon resection was found,who was stopped bleeding by suturing anastomotic stoma at day 3 after operation,and cured.The time of operation and postoperative intestinal peristalsis recovery were 100 to 190 minutes and 1 to 4 days,respectively.The intraoperative blood loss was 40 to 250 ml.Anastomotic leakage and postoperative urinary retention were not found.Postoperative hospital stay was 7 to 12 days.Fourty-six cases were followed up for 1 to 27 months,1 cases with peritoneal metastases was found in 8 months after operation and 2 patients discharged after 6 months restored after conservative treatment in hospital once again because of adhesive ileus.Conclusions： Laparoscopic colorectal-carcinoma surgery is safe,less trauma,less pain and quick recovery.Skilled laparoscopic technology and rich experience in open colorectal surgery for doctor is the key to the success of operation.