腹腔镜结直肠手术55例报告

Laparoscopic Procedures in Colon Resection:A Report of 55 Cases

目的 探讨腹腔镜结直肠手术的优缺点、手术方法及应用价值。 方法 经腹腔镜行结直肠手术 5 5例 ,其中右半结肠切除 15例 ,横结肠癌根治 3例 ,Dixon手术 2 0例 ,乙状结肠癌姑息切除 4例 (其中 2例肝转移癌电凝固化 ) ,左半结肠切除 1例 ,Miles手术 6例 ,乙状结肠腺瘤切除 2例 ,乙状结肠造瘘 1例、直肠悬吊 1例 ,先天性巨结肠切除 2例。 结果 5 4例成功完成手术 ,肿瘤侵犯十二指肠及胰头而中转开腹 1例。手术时间平均 14 8.8分钟。术后平均 30 .9小时胃肠功能恢复 ,且无并发症发生 ,术后平均住院 7.6天。随访 1～ 6 6月 ,1例横结肠癌术后 2 3月出现肺转移 ,32月死亡 ;1例乙状结肠癌伴肝转移术后 2 3月出现别处肝转移 ,开腹行右半肝切除。 结论 腹腔镜结直肠手术技术上是可行的 ,具有手术创伤小、术后恢复快、胃肠道干扰小、术后疼痛轻、疤痕小等优点 ,值得进一步探索。

Objective To gain an insight into the value, benefit and procedures of laparoscopy in colon or rectum surgery.Methods Fifty five cases of colon procedures were performed with laparoscopy.The patients' ages ranged from 3 months to 82 years.The procedures included right hemicolectomy (n=15),left hemicolectomy (n=1),miles procedures (n=6),suspension for prolapse of the rectum (n=1),transverse colon cancer radical resection (n=3),sigmoid colon cancer radical resection (n=20),sigmoid colon cancer palliative resection (n=2), sigmoid colon cancer palliative resection and electrocautery for liver metastatic focus (n=2),colon portion resection for adenoma (n=2), pelvirectal achalasin resection (n=2), and sigmoidostomy (n=1). Results Fifty four cases were successfully done.The average length of postoperative stay was 7.6 days.One case required conversion to open laparotomy.There was no complication. Conclusion Given these preliminary results,we believe that laparoscopic colon procedures can be carried out safely and effectively with decreased postoperative pain and rapid recovery.