腹腔镜结直肠手术的临床应用

Clinical application of laparoscopic surgery for colorectal neoplasm

目的 总结腹腔镜结直肠手术的临床应用经验。 方法 运用腹腔镜技术 ,按开放手术原则治疗结直肠癌 32例 ,其中右半结肠切除术 2例 ,乙状结肠切除术 2例 ,直肠癌行直肠前切除术 (Dixon术式 ) 19例 ,Miles术式 9例。 结果 31例手术成功 ,1例上段直肠癌因侵及膀胱后壁中转开腹手术。手术时间 110～ 2 10min ,平均 16 0min。术中出血量 4 0～ 30 0ml,平均 15 0ml。术后 1～ 3d肠蠕动恢复 ,平均 1 6d。无术后出血、吻合口漏、尿潴留等并发症 ,2例术后性功能障碍。术后住院 5～ 8d ,平均 7d。随访 32例 ,时间 1～ 18个月 ,平均 6个月 ,1例腹腔内广泛转移。 结论 腹腔镜结直肠手术安全可行。严格掌握手术适应证、熟练的腹腔镜手术技术和丰富的开腹结直肠手术经验是完成此类手术的关键。

Objective To summarize the clinical experience of laparoscopic surgery for colorectal neoplasm. Methods In compliance with principles of open surgery, laparoscopic operations were applied to 32 cases of colorectal neoplasm. The operations included 2 cases of right hemicolectomy, 2 cases of sigmoidectomy, 19 cases of rectal anterior resection (Dixon) and 9 cases of abdominal perineal resection (Miles). Results Laparoscopic surgery was successfully completed in 31 cases while a conversion to open surgery was required in 1 case of upper rectal cancer penetrating into the posterior bladder wall. The mean operation time was 160 min, and the mean intraoperative blood loss was 150ml.The bowel movement recovered at a mean of 1.6 postoperative days. No postoperative bleeding, anastomotic leakage or urinary retention occurred, and postoperative sexual dysfunction was observed in 2 cases. All the patients were followed for 1～18 months (mean, 6 months) and a widespread metastasize in abdominal cavity was seen in 1 case. Conclusions Laparoscopic colorectal operations are feasible and safe. In order to smoothly accomplish the operations it is crucial that the surgical indications should be strictly followed and the procedures performed by skilled surgeons.