CAJ | 학술논문

目的研究一种无切口腹腔镜技术在高位直肠及乙状结肠肿瘤微创外科治疗中的可行性并初步探讨其临床应用价值.方法对12例常规腹腔镜下高位直肠及乙状结肠肿瘤的离体标本进行研究,初步探索该新技术的适应证.并对2例应用该技术的手术病例进行临床资料的分析,通过随访了解其长短期并发症情况.结果 12例连续的高位直肠及乙状结肠离体标本中腺瘤1例、腺癌11例,其中腺瘤病例和4例腺癌病例可在离体标本水平成功模拟该新技术.在初步明确无切口腹腔镜技术的适应证后,成功将该术式应用于1例高位直肠巨大绒毛状腺瘤伴局部癌变病例及1例乙状结肠腺癌病例的微创治疗中.平均手术时间为200 min,平均术中出血量为75 ml,平均肠功能恢复时间为1.5 d,术后平均随访14个月,无任何长短期并发症.结论无切口腹腔镜技术符合肿瘤根治的原则,在符合适应证的病例中安全可行.与传统术式相比该技术可以简化手术环节,进一步减小创伤,节省手术费用.
목적 연구일충무절구복강경기술재고위직장급을상결장종류미창외과치료중적가행성병초보탐토기림상응용개치.방법 대12례상규복강경하고위직장급을상결장종류적리체표본진행연구,초보탐색해신기술적괄응증.병대2례응용해기술적수술병례진행림상자료적분석,통과수방료해기장단기병발증정황.결과 12례련속적고위직장급을상결장리체표본중선류1례、선암11례,기중선류병례화4례선암병례가재리체표본수평성공모의해신기술.재초보명학무절구복강경기술적괄응증후,성공장해술식응용우1례고위직장거대융모상선류반국부암변병례급1례을상결장선암병례적미창치료중.평균수술시간위200 min,평균술중출혈량위75 ml,평균장공능회복시간위1.5 d,술후평균수방14개월,무임하장단기병발증.결론 무절구복강경기술부합종류근치적원칙,재부합괄응증적병례중안전가행.여전통술식상비해기술가이간화수술배절,진일보감소창상,절성수술비용.
Objective To explore the feasibility of a novel incisionless laparoscopic technique in the treatment of colorectal tumor, and evaluate the preliminary clinical result of this technique. Methods The clinical data of 12 consecutive resected specimens of high located rectal or sigmoid tumor removed by traditional laparoscopic surgery were analyzed to probe the indication of this technique and the first 2 cases received incisionless laparoscopic anterior resection. Postoperative follow up was made to evaluate the clinical feasibilities. Results Among 12 explanted fresh specimens there were 1 adenoma and 3 adenocarcinoma cases in which the key steps of the new technique were successfully demonstrated. In two cases, the bowel above the tumor was cut and the distal end was inverted and pulled through the anus laparoscopically, the tumor along with the bowel resected, the stump pushed hack, and intralumen sigmoidproctostomy fashioned. In these two patients, one of sigmoid cancer and one of large rectal adenoma with focal canceration, the mean operation time was 200 min, mean blood lose was 50 ml, mean bowel function recovery time was 1.5 days. After 13 and 15 respective months fullow up there was no complications nor tumor recurrence. Conclusions Ineisionless laparoscopic surgery, while in line with tumor free principles, has the advantage of safety, cost-effectiveness and being cosmetic in selected cases.