腹腔镜辅助下结直肠癌切除手术的临床应用
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张翼

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Clinical application of laparoscopic-assisted surgery for of colorectal cancer
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    目的:探讨腹腔镜辅助下结直肠癌切除手术的可行性和应用价值。方法:回顾性分析51例腹腔镜结直肠癌切除手术的临床资料。腹腔镜下完成结直肠手术48例,中转开腹3例。其中右半结肠切除术9例,左半结肠切除术8例, 乙状结肠切除术14例,直肠前切除术11例,腹会阴联合根治术6例。结果:全组无手术死亡。腹腔镜手术时间150~320(平均195)min,术中出血40~300(平均120)mL,手术清除淋巴结2~26(平均8)枚。术后20~72h 均恢复胃肠功能,术后疼痛轻,无术中大出血、术后无特殊并发症发生。术后住院时间(不包括化疗)7~10(平均8)d。随访45例(88.2%),随访时间3~54个月, 2例死亡,均为Dukes C期直肠癌患者,1例术后17个月死于肝转移,另1例术后19个月死于腹腔广泛转移并衰竭。未发现套管穿刺部位及辅助小切口处肿瘤种植和局部复发。结论:腹腔镜结直肠癌手术在应用技术上可行,且具有创伤小、痛苦少、恢复快等特点,是治疗结直肠癌的一种微创、安全而有效的术式。

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    Abstract:Objective: To explore the feasibility and value of laparoscopic-assisted surgery(LAS) for colorectal cancer. Methods:The clinical data of 51 cases of LAS for colorectal cancer were reviewed retrospectively. Of them, 3 cases were converted to open operation, and in 48 cases LAS for colorectal cancer was completed. Among them,9 cases underwent right hemicolectomy,8 cases left hemicolectomy,14 cases sigmoid resection,9 cases rectal anterior resection, and 6 cases Miles operation. Results:No intra-operative deaths occurred. The average operation time was 195(150-320)min with 120(40-300)mL average blood loss.The average number of lymph nodes excised was 8(2-26).The time of bowel function recovery was 20-72h after operation.The average hospital stay after operation was 8(7-10)d.No major intra-operative blood loss nor postoperative complications were observed.The follow-up time was from 3-54months for 45(88.2%) patients. Two cases with Ducke′s C rectal cancer died,one died of liver metastasis 17 months after operation, and the another died of diffuse peritoneal metastasis 19 months after operation. There was no trocar port tumor metastasis and no local tumor recurrence at the small abdominal incision. Conclusions:LAS of colorectal cancer is technically feasible and has advantages such as less surgical trauma,less bleeding and quick recovery. It is a mini-invasive, safe and efficient treatment for colorectal cancer.

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张翼,吴君辉,钱立元,李小荣,陈道瑾.腹腔镜辅助下结直肠癌切除手术的临床应用[J].中国普通外科杂志,2006,15(8):2-568.
DOI:10.7659/j. issn.1005-6947.2006.08.002

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  • 在线发布日期: 2006-08-25