腹腔镜下结肠脾曲游离的手术技巧

Surgical technique of laparoscopic separation of colonic splenic flexure

目的:总结腹腔镜左半结肠切除术中结肠脾曲的游离方法及技巧。方法:回顾分析2013年6月至2014年6月为20例患者行腹腔镜左半结肠切除术的临床资料。结果:20例手术均获成功。手术时间平均(180±30)min,术中出血量平均(90±60)ml。切除肠管长度平均(25.0±2.3)cm,肿瘤直径平均(4.4±1.5)cm,平均检出淋巴结(16.0±3.6)枚。术后肛门排气时间平均(3.0±1.5)d,1例患者于术后第10天发生吻合口瘘,经局部双套管冲洗引流后痊愈;2例患者出现肺部感染、胸腔积液,经抗感染治疗后痊愈;2例患者出现辅助切口脂肪液化,经切口引流换药后痊愈。均无围手术期死亡病例,术后平均住院(13.0±3.5)d。术后平均随访(24.0±5.5)个月,发生肝转移1例,行肝转移灶切除术,患者恢复良好。结论:腹腔镜下结肠脾曲游离是安全、有效的,通过正确的Toldt间隙、合理的分离顺序,可顺利完成腹腔镜下结肠脾曲的游离。

Objective：To summarize the methods and skills for separation of colonic splenic flexure in laparoscopic left hemicolectomy.Methods：A retrospective analysis was performed on clinical data of 20 patients who underwent laparoscopic left hemicolectomy from Jun.2013 to Jun.2014.Results：All 20 operations were successful without perioperative death.The operation time was （180±30） min.Intraoperative blood loss was （90±60） ml.The length of the resected colon was （25.0±2.3） cm.Tumor diameter was （4.4±1.5） cm.The harvested number of lymph nodes was （16.0±3.6）.The flatus time was （3.0±1.5） d.1 patient suffered from anastomotic leakage on the 10th day after operation,and was cured after local irrigation and drainage through double-cannula.2 cases of pulmonary infection and hydrothorax occurred and were cured by anti-infection treatment.2 cases of fat liquefaction were found at assisted incisions and cured after drainage and dressing change.Postoperative hospital stay was （13.0±3.5） d.The patients were followed up for （24.0±5.5） months,1 patient with liver metastases underwent resection of liver metastases and recovered well.Conclusions：Laparoscopic separation of colonic splenic flexure is safe and efficient.Advance through the correct Toldt interval and rational order of separation are important for the successfully laparoscopic separation of colonic splenic flexure.