腹腔镜下手术切除结直肠癌的临床分析
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程应东

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Clinical analysis of laparoscopic resection of colorectal cancer
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    摘要:

    探讨腹腔镜下行结直肠肿瘤手术的可行性。方法:回顾性分析近3年110例腹腔镜下行结直肠癌切除手术的临床资料。中转开腹24例,腹腔镜下完成结直肠手术86例。其中右半结肠切除术5例,左半结肠切除术2例,乙状结肠切除术10例,Dixon术22例,Miles术46例,全大肠切除术1例。结果:全组无手术死亡病例。腹腔镜手术时间120~360(平均225)min,术中出血20~400(平均135)mL。淋巴结切除数1~30(平均8.7)个,阳性淋巴结数0~24(平均2.2)个。术中发生并发症6例:包括输尿管损伤1例,出血5例,均经及时中转手术解决。术后发生尿瘘2例,大出血2例,肠梗阻2例,均经再手术治愈。术后12~72h均恢复胃肠功能。术后住院7~15(平均8.6)d。随访100例(90.9%),随访时间1~33(平均14.3)个月。1例Miles术后3个月发生会阴部转移;3例术后6~15个月腹腔广泛种植转移。未发现套管针穿刺部位及小切口部位肿瘤转移。结论:腹腔镜下行结直肠肿瘤切除手术在技术上是可行的,且具有创伤小、出血少、胃肠干扰少、术后疼痛轻、恢复快等优点,可以达到安全根治性切除肿瘤的目的。

    Abstract:

    Objective:To study the feasibility of laparoscopic resection of colorectal cancer. Methods:A retrospectively analysis of the clinical data of 110 patients with colorectal cancer treated by laparoscopic resection during last three years was made. Of them, 24 cases were converted to open operation.In 86 cases, laparoscopic resection of colorectal cancer was completed. Among them, 5 cases underwent right hemicolectomy, 2 cases left hemicolectomy,10 cases sigmoidectomy, 22 cases Dixon′s operation, 46 cases of Miles operation, and 1 case total colorectomy. Results:No patient died within 30 days postoperatively in this series. The average operation time was 225 (120360) min with average 135 (20400) mL blood loss.The average number of lymph nodes excised was 8.7 (130). The average number of positive lymph nodes was 2.2 (024). Six cases had intraoperative complications, including 1 case of ureteral injury and 5 cases of intraabdominal bleeding. These patients were immediately converted to open surgery. There were 6 cases with postoperative complications, among them, 2 cases of urinary leakage, 2 cases of massive bleeding and 2 cases of intestinal obstruction. All of them recovered after reoperation.The time of bowel funtion recovering was 1272h after operation. The hospital stay after operation was 8.6 (715)days. The median followup was 14.3 months (range 133) for 100 (90.9%) patients. There was no portsite tumor metastasis and no tumor recurrence at the small abdominal incision. Six to fifteen months after opteration, 3 cases had diffase peritoneal metastases.1 case of Miles resection had perineal metastasis 3 months after surgery. Conclusions:Laparoscopic resection of colorectal cancer is technically feasible,and have advantages, such as less surgical trauma, less bleeding, less gastrointestinal interference and quicker recovery.Laparoscopic radical operation for colorectal cancer can meet the requirements of safety and radical operation.

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程应东,梁平,张朝军,罗云生.腹腔镜下手术切除结直肠癌的临床分析[J].中国普通外科杂志,2005,14(12):2-886.
DOI:10.7659/j. issn.1005-6947.2005.12.002

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  • 在线发布日期: 2005-12-25