常规器械经脐减孔腹腔镜结直肠癌根治术的临床应用

Clinical Application of Transumbilical Incision Reduced Port Laparoscopic Radical Resection with Conventional Laparoscopic Instruments for Colorectal Cancer

目的探讨常规器械经脐减孔腹腔镜结直肠癌根治术的安全性及可行性。方法回顾性分析2015年10月~2016年12月经脐减孔腹腔镜结直肠癌根治术47例的临床资料,取经脐或脐下切口4~5 cm,切口保护套及手套自制单孔操作通路,置入1个10 mm及2个5 mm trocar,右下腹或左上腹置入12 mm trocar,行经脐减孔腹腔镜结直肠癌根治术,切除标本经脐或脐下切口取出,经左或右侧腹戳孔置入引流管1根。结果行右半结肠癌根治术15例,横结肠癌根治术2例,左半结肠癌根治术6例,乙状结肠癌根治术8例,Dixon直肠癌根治术16例(其中低位直肠癌根治术2例),手术均顺利完成,无中转常规多孔腹腔镜或开腹。TNM分期Ⅰ期9例,Ⅱ期16例,Ⅲ期20例,Ⅳ期2例。术后5例并发症(吻合口漏1例,切口感染3例,胃瘫1例),无围术期死亡。结论常规器械经脐减孔腹腔镜结直肠癌根治术安全、可行。

Objective To evaluate the safety and utility of transumbilical incision reduced port laparoscopic radical resection with conventional laparoscopic instruments for colorectal cancer. Methods The clinical data of 47 patients with colorectal cancer undergoing reduced port laparoscopic radical resection from October 2015 to December 2016 in our hospital were retrospectively analyzed. The self-made single port device with protector of incision and gloves was located through a 4-5 cm incision transumbilical or subumbilical involving one 10-mm port and two 5-mm ports. Another 12-mm port was located at the right lower or left upper abdomen. After accomplishment of resection,the specimen was extracted through the transumbilical or subumbilical incision,and a drainage tube was placed from the port at the right or left abdomen. Results All the operations were performed successfully without conversion to conventional laparoscopic surgery or open operation,including 15 cases of reduced port laparoscopic right colonic carcinoma radical resection,2 cases of transverse colonic carcinoma radical resection,6 cases of left colonic carcinoma radical resection,8 cases of sigmoid colonic carcinoma radical resection,and 16 cases of Dixon rectal carcinoma radical resection（ including 2 cases of low rectal carcinoma）. The TNM stages were stage Ⅰ in 9 cases,stage Ⅱ in 16 cases,stage Ⅲ in 20 cases and stage Ⅳin 2 cases. Postoperative complications included 1 case of anastomotic leakage,3 cases of incision infection and 1 case of gastric retention. There was no perioperative death. Conclusion Transumbilical incision reduced port laparoscopic radical resection with conventional laparoscopic instruments is safe and feasible for colorectal cancer patients.