腹腔镜直肠癌根治术并发症分析及防治体会

Analysis and control of the complications of laparoscopic radical operation for rectal cancer

目的:探讨腹腔镜直肠癌根治术常见的并发症及防治体会。方法:回顾分析2011年7月至2014年7月78例行腹腔镜直肠癌根治术患者的临床资料,手术均顺利完成,其中Miles术28例,Dixon术50例。记录患者并发症发生情况,分析其相关因素,并进行相应处理。结果:本组无围手术期死亡病例。术中肠管损伤2例,修补后痊愈;术后出现吻合口出血2例,予压迫、止血治疗后痊愈;吻合口漏1例,予以腹腔双套管冲洗、引流、营养支持等保守治疗后痊愈;肠梗阻5例,予禁食、胃肠减压、营养支持治疗后痊愈。患者术后均痊愈出院。结论:不断提高腹腔镜手术操作技巧,严格按照腹腔镜直肠癌手术操作规范施术,重视关键步骤的解剖及操作程序,是防治腹腔镜直肠癌手术并发症的关键。

Objective： To investigate the common complications and their control measures of laparoscopic radical operation for rectal cancer. Methods： Retrospective analysis was made on the clinical data of 78 patients who underwent laparoscopic radical operation for rectal cancer during Jul. 2011 and Jul. 2014. All the laparoscopic operations were smoothly completed,including 28 cases of Miles surgery and 50 cases of Dixon surgery. The complications were recorded and treated,the related factors were analyzed. Results： No perioperative mortality occurred. 2 cases of intraoperative intestinal injury were cured after repair. 2 cases of postoperative anastomotic bleeding were cured after oppression and hemostatic therapy. 1 case of anastomotic leakage recovered after abdominal double-tube irrigation,drainage and nutritional support. 5 cases of intestinal obstruction were cured after fasting,gastrointestinal decompression and nutritional support. All patients were cured and discharged from hospital. Conclusions： Continuous improvement of the laparoscopic operation skill,in strict accordance with the operation specification of laparoscopic rectal cancer surgery,paying attention to the anatomy and operation procedure of critical steps,are the keys of prevention and treatment for complications of laparoscopic rectal cancer operation.