CAJ | 학술논문

目的探讨经脐单孔腹腔镜结直肠手术的临床应用价值.方法回顾性分析2010年1月至2012年12月自贡市第四人民医院收治的25例结肠、直肠上段良恶性肿瘤行手术切除患者的临床资料.根据病变的部位和性质确定手术方案.采用门诊和电话随访,随访时间截至2013年3月.结果 25例患者中行结直肠部分切除术14例,根治性右半结肠切除术1例,横结肠癌根治术1例,根治性左半结肠切除术1例,乙状结肠癌根治术2例,直肠癌根治术6例.22例患者成功施行经脐单孔腹腔镜结直肠手术,2例改为“四孔法”手术,1例中转开腹手术.单孔腹腔镜手术中位切口长度为3.8cm(3.5～4.5cm),手术时间为(192±32) min,术中出血量为(61±21)mL,肿瘤中位长径为2.7 cm(1.0～5.0 cm),中位淋巴结清扫数目为7枚(3～22枚),术后平均肛门排气时间为2 d(1 ～5 d),术后平均住院时间为8 d(6 ～20 d).患者术后并发症发生率为8.0％(2/25),包括切口感染1例,吻合口漏1例.11例行根治手术的患者肿瘤环周切缘均为阴性.22例行经脐单孔腹腔镜结直肠手术的患者均接受随访,中位随访时间为12个月.1例结肠癌患者术后10个月发现肝转移,其余患者均无瘤生存.结论经脐单孔腹腔镜结直肠手术安全可行,创伤小、恢复快、并发症少、切口美观.
목적 탐토경제단공복강경결직장수술적림상응용개치.방법 회고성분석2010년1월지2012년12월자공시제사인민의원수치적25례결장、직장상단량악성종류행수술절제환자적림상자료.근거병변적부위화성질학정수술방안.채용문진화전화수방,수방시간절지2013년3월.결과 25례환자중행결직장부분절제술14례,근치성우반결장절제술1례,횡결장암근치술1례,근치성좌반결장절제술1례,을상결장암근치술2례,직장암근치술6례.22례환자성공시행경제단공복강경결직장수술,2례개위“사공법”수술,1례중전개복수술.단공복강경수술중위절구장도위3.8cm(3.5～4.5cm),수술시간위(192±32) min,술중출혈량위(61±21)mL,종류중위장경위2.7 cm(1.0～5.0 cm),중위림파결청소수목위7매(3～22매),술후평균항문배기시간위2 d(1 ～5 d),술후평균주원시간위8 d(6 ～20 d).환자술후병발증발생솔위8.0％(2/25),포괄절구감염1례,문합구루1례.11례행근치수술적환자종류배주절연균위음성.22례행경제단공복강경결직장수술적환자균접수수방,중위수방시간위12개월.1례결장암환자술후10개월발현간전이,기여환자균무류생존.결론 경제단공복강경결직장수술안전가행,창상소、회복쾌、병발증소、절구미관.
Objective To investigate the clinical value of transumbilical single-port laparoscopic colorectal operation.Methods The clinical data of 25 patients with benign or malignant carcinoma at the upper part of the colon or rectum who were admitted to the No.4 People's Hospital of Zigong from January 2010 to December 2012 were retrospectively analyzed,and the clinical experience of transumbilical single-port laparoscopic colorectal operation was summarized.Surgical procedure was selected according to the position and nature of the lesion.Patients were followed up via out-patient examination and phone call till March 2013.Results Partial colorectal resection was done on 14 patients,radical resection of right colon on 1 patient,radical resection of transverse colon on 1 patient,radical resection of left colon on 1 patient,radical resection of sigmoid colon on 2 patients and radical rectectomy on 6 patients.The operation was successfully carried out on 22 patients,2 patients received four-port laparoscopic colorectal operation,and 1 patient was converted to open surgery.The median length of the incision of single-port laparoscopic colorectal operation was 3.8 cm (range,3.5-4.5 cm),and the operation time was (192 ± 32) minutes.The intraoperative blood loss was (61 ± 21)mL,and the median diameter of the tumor was 2.7 cm (range,1.0-5.0 cm).The median number of lymph nodes dissected was 7 (range,3-22),the mean time of postoperative anal exhaust time was 2 days (range,1-5 days),and the mean time of postoperative hospital stay was 8 days (range,6-20 days).The incidence of postoperative complications was 8.0％ (2/25),including 1 patient with wound infection and 1 patient with anastomotic leakage.The circumferential resection margins of radically resected specimens were negative in 11 patients.Twenty-two patients who received transumbilical single-port laparoscopic colorectal resection were followed up,and the median time of follow-up was 12 months.Colorectal liver metastasis was detected on 1 patient at postoperative month 10,and the other patients survived without tumor recurrence or metastases.Conclusions Transumbilical singleport laparoscopic colorectal operation is safe,micro-traumatic and feasible,and it also has less complication and good cosmetic effect.