腹腔镜手术治疗结直肠良恶性病变103例分析

ANALYSIS ON LAPAROSCOPIC COLORECTAL SURGERY FOR BENIGN AND MALIGNANT DISEASE IN 103 PATIENTS

目的 :探讨腹腔镜手术治疗结直肠良恶性病变的应用价值。方法 :回顾分析经腹腔镜行结直肠手术 10 3例 ,其中良性病变 17例、恶性病变 86例 ,包括右半结肠切除 19例 ,横结肠切除术 8例 ,左半结肠切除 5例 ,乙状结肠切除 12例 ,先天性巨结肠切除 10例 ,全结肠切除 1例 ,乙状结肠造瘘术 2例 ;直肠前切除术 32例 ,腹会阴切除术 12例 ,直肠悬吊术 1例。结果 :10 2例成功完成腹腔镜手术 ,1例因肿瘤侵犯十二指肠及胰头而中转开腹。手术时间平均 14 6 .8min ,术后肠功能恢复平均 30 .6h ,术后平均住院 7.4d。 2例低位直肠癌保肛术后并发吻合口瘘。随访 3～ 90月 ,平均随访 2 6月 ,腹腔镜结直肠癌根治术后生存率为 89.2 % (74 /83)。结论 :腹腔镜结直肠手术具有创伤小、术后恢复快的优点 ,处理结直肠良性病变优势明显 ,对结直肠恶性肿瘤治疗 ,近期疗效尚可、远期疗效评价尚待进一步观察。

Objective:To explore the application of laparoscopy in colorectal surgery for benign and malignant diseases. Methods:One hundred and three patients with laparoscopic colorectal surgery were reviewed. Of them, 17 patients with benign disease and 86 patients with malignant disease. Ninteen laparoscopic right colectomies, 8 transverse colectomies, 17 laparoscopic left or sigmoid colectomies, 32 laparoscopic low anterior resections, and 12 laparoscopic abdominoperineal resections ,including 15 other laparoscopic colorectal operations were performed with a 3～90 months follow-up.Results:One hurdred and two cases were successfully done laparoseopically and 1 case converted to laparotomy for the duodeul and pancreatic head invasion of colonic cancer. The average operative time was 146.8 minutes, the average recovery time of postoperative intestine function was 30.6 hours and the length of postoperative hospital stay was 7.4 days. Two cases had anastomotic leakage after laparoscopic low anterior resections .At the median follow-up of 26 months, the recurrence-free survival rates of the 83 cases with colorectal cancer was 89.2%.Conclusions: For benign disease laparoscopic colorectal surgery is ideal for its shorter recovery period and minimal invasion. For malignant disease, the initial postoperative effect of laparoscopic colorectal resection was available while the far oncologic outcomes have not been determined.