【摘要】 目的探讨腹腔镜结直肠癌根治术的近期疗效及并发症。方法回顾性分析2012年7月至2014年6月,昆明市第一人民医院普外科施行的54例腹腔镜辅助结直肠癌根治术的临床资料。其中直肠癌行Dixon术27例,右半结肠切除术12例,Miles术8例,乙状结肠切除术4例,左半结肠切除术3例。结果除外2例中转开腹,其余52例均在腹腔镜辅助下顺利完成手术,无手术死亡病例;结肠癌切除包括肿块在内的11~26 cm肠管;直肠癌行Dixon术或Miles术时,下端切缘距肿瘤下缘1~3 cm,术中冰冻及术后病理证实所有标本残端均无肿瘤细胞残留、浸润。手术时间112~325 min,平均手术时间186 min;术中出血30~400 ml,平均术中出血120 ml;术后排气时间36~72 h,平均术后排气时间48 h;淋巴结清扫9~21枚,平均淋巴结清扫14.5枚。术后无出血、吻合口狭窄等并发症发生;2例会阴部切口感染,经过换药后痊愈;1例术后2 d因吻合口瘘再次开腹造瘘,1例造瘘口肠坏死回缩,5个月后经原造瘘口再次造瘘术;1例Dixon术后附加小肠造瘘口肠套叠麻醉后手法复位。术后住院时间9~28 d,平均术后住院时间15.2 d。术后电话随访至2015年3月。电话随访期内,死亡2例;局部复发2例;肝转移1例;1例再发肠梗阻行复发肿瘤切除,回肠造瘘;1例Miles术后闭孔内肌旁复发,再次经肛肿瘤切除术;其余均未发现转移、复发及切口种植。结论腹腔镜辅助结直肠癌根治术具有患者创伤小、出血少,操作安全、术后并发症少等优点,可取得与传统开腹手术媲美的治疗效果。更多还原

【Abstract】 Objective To analyze the short-term outcome and complication of the laparoscopicassisted radical operation of colorectal cancer.Methods The clinical data of 54 patients with colorectal cancer performed laparoscopic colorectectomy from Jul.2012 to Jun.2014 in our department were analyzed retrospectively,among them,12 cases performed right hemicolectomy,4 cases by sigmoid colorectomy,3 cases by left hemicolorectomy,27 cases by rectal anterior resection and 8 cases by Miles operation.Results The laparoscopic-assisted radical operation was performed on 52 cases successfully,and 2 cases converted to laparotomy.No one died during operation.Colon cancer was resected including tumors and about 11-26 cm intestine.Rectal cancer underwent Miles or Dixon surgery.the bottom incision margin from the inferior border of tumor was 1-3 cm.Postoperative pathological examination revealed no residual or infiltration of tumor cells in stump.The operation time was 112-325 min( mean,186 min),and the intraoperative blood loss was 30-400 ml( mean,120 ml).The postoperative convalescence of intestinal peristalsis was 36-72 hours( mean,48 hours).9-21 lymph nodes were resected( mean,14.5); There were no operative complications such as hemorrhage,anastomotic stenosis.Infection of incision wound of perineal region occurred in 2 case,anastomotic leakage in 1 case,and 2 days later was treated by colostomy; intestine necrosis of stroma in1 case and 5 month later was treated by colostomy; Intestinal intussusception occurred in 1 case and then reduction by hand.The post-operative hospital stay was 9-28 days,with an average of 15.2 days.After surgery,telephone followed up to Mar.2015,one died and 2 had local recurrence.Other one has liver metastasis.And other patients in the follow-up period,no metastasis,recurrence or incision implantation were found.Conclusions The laparoscopic-assisted radical operation of colorectal cancer is not only technologically feasible and safe with less trauma,pain and complication,but also completely effective comparing to the open colorectomy.更多还原