腹腔镜全结肠切除治疗家族性腺瘤性息肉病12例

Clinical Experience of Laparoscopic Total Colectomy for Familial Adenomatous Polyposis

目的探讨腹腔镜全结肠切除术治疗家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)的可行性及安全性。方法回顾性分析2015年6月~2018年12月腹腔镜全结肠切除术治疗12例FAP的临床资料,4例癌变者行腹腔镜全结肠直肠切除、末段回肠造口术,6例直肠下段未扪及明显息肉者行腹腔镜全结肠切除、直肠次全切除、回肠J形储袋直肠吻合术,2例直肠下段有少量息肉者行腹腔镜全结肠切除及直肠次全切除、残留直肠黏膜剥脱、经直肠肌鞘内回肠肛管吻合术。结果12例均顺利完成手术,无中转开腹,术后2~3天肛门排气,住院时间8~12 d。随访3~24(13±3)月,无近期并发症发生,除回肠造口4例外,其余8例术后控便较好,3个月后大便能控制在3~6次/日。结论腹腔镜全结肠切除术治疗FAP创伤小,恢复快,安全,有效。

Objective To explore the feasibility and safety of treating familial adenomatous polyposis(FAP)with laparoscopic total colectomy.Methods The clinical data of 12 FAP patients who underwent laparoscopic total colectomy from June 2015 to December 2018 were analyzed.Laparoscopic total colectomy and terminal ileostomy were performed in 4 patients with canceration;laparoscopic total colectomy,subtotal rectal resection and J-shaped ileal pouch-rectal anastomosis were performed in 6 patients with undisturbed or obvious polyps in the lower rectum;and laparoscopic total colectomy and subtotal rectal resection,residual rectal mucosal stripping,intrarectal ileo-anal anastomosis were performed in 2 patients with small polyps in the lower rectum.Results All of the 12 patients received successful laparoscopic total colectomy without conversion to laparotomy.All patients recovered well,with the detection of first flatus 2-3 days after operation.The time of hospitalization was 8-12 days respectively.The 12 patients were followed up for 3-24 months(13±3 months)and no complication was observed.Four patients received ileum colostomy,while the other eight patients had bowel movements 3-6 times daily after 3 months.Conclusion The laparoscopic total colectomy for FAP can be performed effectively and safely with the advantages of minimal invasion and quick recovery.