中华腔镜外科杂志（电子版）
中華腔鏡外科雜誌（電子版）
중화강경외과잡지（전자판）
CHINESE JOURNAL OF LAPAROSCOPIC SURGERY ( ELECTRONIC EDITION)
2015年
2期
34-36
,共3页
余少鸿%朱磊%汤荣春%杨杰%温小明
餘少鴻%硃磊%湯榮春%楊傑%溫小明
여소홍%주뢰%탕영춘%양걸%온소명
结直肠癌%腹腔镜辅助技术%病例报告
結直腸癌%腹腔鏡輔助技術%病例報告
결직장암%복강경보조기술%병례보고
Colorectal cancer%Laparoscopic-assisted technique%Case report
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。
目的：探討腹腔鏡結直腸癌根治術的近期療效及併髮癥。方法迴顧性分析2012年7月至2014年6月，昆明市第一人民醫院普外科施行的54例腹腔鏡輔助結直腸癌根治術的臨床資料。其中直腸癌行 Dixon 術27例，右半結腸切除術12例，Miles 術8例，乙狀結腸切除術4例，左半結腸切除術3例。結果除外2例中轉開腹，其餘52例均在腹腔鏡輔助下順利完成手術，無手術死亡病例；結腸癌切除包括腫塊在內的11～26 cm 腸管；直腸癌行 Dixon 術或 Miles 術時，下耑切緣距腫瘤下緣1～3 cm，術中冰凍及術後病理證實所有標本殘耑均無腫瘤細胞殘留、浸潤。手術時間112～325 min，平均手術時間186 min；術中齣血30～400 ml，平均術中齣血120 ml；術後排氣時間36～72 h，平均術後排氣時間48 h；淋巴結清掃9～21枚，平均淋巴結清掃14．5枚。術後無齣血、吻閤口狹窄等併髮癥髮生；2例會陰部切口感染，經過換藥後痊愈；1例術後2 d 因吻閤口瘺再次開腹造瘺，1例造瘺口腸壞死迴縮，5箇月後經原造瘺口再次造瘺術；1例 Dixon 術後附加小腸造瘺口腸套疊痳醉後手法複位。術後住院時間9～28 d，平均術後住院時間15．2 d。術後電話隨訪至2015年3月。電話隨訪期內，死亡2例；跼部複髮2例；肝轉移1例；1例再髮腸梗阻行複髮腫瘤切除，迴腸造瘺；1例 Miles術後閉孔內肌徬複髮，再次經肛腫瘤切除術；其餘均未髮現轉移、複髮及切口種植。結論腹腔鏡輔助結直腸癌根治術具有患者創傷小、齣血少，操作安全、術後併髮癥少等優點，可取得與傳統開腹手術媲美的治療效果。
목적：탐토복강경결직장암근치술적근기료효급병발증。방법회고성분석2012년7월지2014년6월，곤명시제일인민의원보외과시행적54례복강경보조결직장암근치술적림상자료。기중직장암행 Dixon 술27례，우반결장절제술12례，Miles 술8례，을상결장절제술4례，좌반결장절제술3례。결과제외2례중전개복，기여52례균재복강경보조하순리완성수술，무수술사망병례；결장암절제포괄종괴재내적11～26 cm 장관；직장암행 Dixon 술혹 Miles 술시，하단절연거종류하연1～3 cm，술중빙동급술후병리증실소유표본잔단균무종류세포잔류、침윤。수술시간112～325 min，평균수술시간186 min；술중출혈30～400 ml，평균술중출혈120 ml；술후배기시간36～72 h，평균술후배기시간48 h；림파결청소9～21매，평균림파결청소14．5매。술후무출혈、문합구협착등병발증발생；2례회음부절구감염，경과환약후전유；1례술후2 d 인문합구루재차개복조루，1례조루구장배사회축，5개월후경원조루구재차조루술；1례 Dixon 술후부가소장조루구장투첩마취후수법복위。술후주원시간9～28 d，평균술후주원시간15．2 d。술후전화수방지2015년3월。전화수방기내，사망2례；국부복발2례；간전이1례；1례재발장경조행복발종류절제，회장조루；1례 Miles술후폐공내기방복발，재차경항종류절제술；기여균미발현전이、복발급절구충식。결론복강경보조결직장암근치술구유환자창상소、출혈소，조작안전、술후병발증소등우점，가취득여전통개복수술비미적치료효과。
Objective To analyze the short-term outcome and complication of the laparoscopic-assisted 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 in 1 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.
