双镜联合结肠手术32例

Combined Laparoscopic-endoscopic Procedure for Colon Tumor: Report of 32 Cases

目的探讨双镜联合结肠手术的经验。方法回顾性分析2011年1月～2014年6月32例双镜联合结肠手术的临床资料,包括内镜辅助腹腔镜手术（术中内镜辅助定位结肠病灶,行腹腔镜结肠肠段切除术或腹腔镜结肠癌根治术）25例和腹腔镜辅助内镜手术（术中腹腔镜监视下行内镜手术切除病灶）7例。结果内镜辅助腹腔镜手术25例,其中内镜辅助腹腔镜结肠癌根治术20例,内镜辅助腹腔镜结肠肠段切除术5例。内镜辅助定位成功率100%（25/25）,腹腔镜下肠段切除、重建和淋巴结清扫,无中转开腹,无手术并发症。25例随访6～48个月,中位时间30个月,1例死于心肌梗死,24例存活,均未见复发和转移征象。腹腔镜辅助内镜手术7例,其中腹腔镜辅助内镜结肠黏膜下剥离术（ESD）3例,腹腔镜辅助内镜结肠黏膜切除术（EMR）2例,腹腔镜辅助内镜结肠息肉切除术2例,1例ESD术中并发穿孔,行腹腔镜下结肠穿孔修补术。7例随访9～36个月,中位时间24个月,无死亡,未见复发的转移征象。结论双镜联合结肠手术可充分发挥两者优势,提高手术安全性,腹腔镜和内镜团队良好的协作与配合有助于提高双镜手术成功率。

Objective To investigate the experience of combined laparoscopic-endoscopic procedure for colon tumor. Methods Clinical data of 32 cases of colon tumor receiving combined laparoscopic-endoscopic procedure from January 2011 to June 2014 were analyzed retrospectively, including 25 cases of endoscopic assisted laparoscopic operation （laparoscopic resection of colon segment or laparoscopic radical resection of colon cancer with positioning of colonic lesions by endoscopy） and 7 cases of laparoscopic assisted endoscopic operation （intraoperative endoscopic resection under the monitor of laparoscopy）. Results Twenty-five cases were performed endoscopic-assisted laparoscopic surgery, including endoscopic-assisted laparoscopic radical resection for colon cancer in 20 cases and endoscopic-assisted laparoseopic segmental resection of colon in 5 cases. The combined procedure contained endoscopic-assisted positioning lesions, laparoscopic bowel resection and reconstruction, and lymph node dissection. The success rate of endoscopic-assisted positioning was 100% （25/25）. No conversion to laparotomy was required. No surgical complications occurred. Follow-up for 6 - 48 months （ median, 30 months） in 25 cases found no signs of recurrence and metastasis. One patient died of myocardial infarction and the remaining 24 patients survived. Seven cases were performed laparoseopic-assisted endoscopic surgery, including laparoscopic-assisted endoscopic submucosal dissection colon （ESD） in 3 cases, laparoscopic-assisted endoscopic mueosal resection （EMR） in 2 cases, and laparoseopic-assisted endoscopic polypectomy in 2 cases. Intestinal perforation occurred during the operation in 1 case of ESD, which was given a laparoscopic colon perforation repair. Follow-up for 9 - 36 months （ median, 24 months） in 7 cases showed no deaths or signs of recurrence and metastasis. Conclusion Combined laparoseopic-endoscopic procedure has advantages of both laparoscopy and endoscopy to improve surgical safety, on the basis of good cooperation of laparoscopic and endoscopic teams.