CAJ | 학술논문

目的：探讨双镜联合结肠手术的经验。方法回顾性分析2011年1月～2014年6月32例双镜联合结肠手术的临床资料，包括内镜辅助腹腔镜手术（术中内镜辅助定位结肠病灶，行腹腔镜结肠肠段切除术或腹腔镜结肠癌根治术）25例和腹腔镜辅助内镜手术（术中腹腔镜监视下行内镜手术切除病灶）7例。结果内镜辅助腹腔镜手术25例，其中内镜辅助腹腔镜结肠癌根治术20例，内镜辅助腹腔镜结肠肠段切除术5例。内镜辅助定位成功率100％（25／25），腹腔镜下肠段切除、重建和淋巴结清扫，无中转开腹，无手术并发症。25例随访6～48个月，中位时间30个月，1例死于心肌梗死，24例存活，均未见复发和转移征象。腹腔镜辅助内镜手术7例，其中腹腔镜辅助内镜结肠黏膜下剥离术（ ESD ）3例，腹腔镜辅助内镜结肠黏膜切除术（ EMR）2例，腹腔镜辅助内镜结肠息肉切除术2例，1例ESD术中并发穿孔，行腹腔镜下结肠穿孔修补术。7例随访9～36个月，中位时间24个月，无死亡，未见复发的转移征象。结论双镜联合结肠手术可充分发挥两者优势，提高手术安全性，腹腔镜和内镜团队良好的协作与配合有助于提高双镜手术成功率。
목적：탐토쌍경연합결장수술적경험。방법회고성분석2011년1월～2014년6월32례쌍경연합결장수술적림상자료，포괄내경보조복강경수술（술중내경보조정위결장병조，행복강경결장장단절제술혹복강경결장암근치술）25례화복강경보조내경수술（술중복강경감시하행내경수술절제병조）7례。결과내경보조복강경수술25례，기중내경보조복강경결장암근치술20례，내경보조복강경결장장단절제술5례。내경보조정위성공솔100％（25／25），복강경하장단절제、중건화림파결청소，무중전개복，무수술병발증。25례수방6～48개월，중위시간30개월，1례사우심기경사，24례존활，균미견복발화전이정상。복강경보조내경수술7례，기중복강경보조내경결장점막하박리술（ ESD ）3례，복강경보조내경결장점막절제술（ EMR）2례，복강경보조내경결장식육절제술2례，1례ESD술중병발천공，행복강경하결장천공수보술。7례수방9～36개월，중위시간24개월，무사망，미견복발적전이정상。결론쌍경연합결장수술가충분발휘량자우세，제고수술안전성，복강경화내경단대량호적협작여배합유조우제고쌍경수술성공솔。
Objective To investigate the experience of combined laparoscopic-endoscopic procedure for colon tumor . Methods Clinical data of 32 cases of colon tumor receiving combined laparoscopic-endoscopic procedure from January 2011 to June 2014 were analyzed retrospectively , including 25 cases of endoscopic assisted laparoscopic operation ( laparoscopic resection of colon segment or laparoscopic radical resection of colon cancer with positioning of colonic lesions by endoscopy ) and 7 cases of laparoscopic assisted endoscopic operation ( intraoperative endoscopic resection under the monitor of laparoscopy ) . Results Twenty-five cases were performed endoscopic-assisted laparoscopic surgery , including endoscopic-assisted laparoscopic radical resection for colon cancer in 20 cases and endoscopic-assisted laparoscopic segmental resection of colon in 5 cases.The combined procedure contained endoscopic-assisted positioning lesions , laparoscopic bowel resection and reconstruction , and lymph node dissection .The success rate of endoscopic-assisted positioning was 100%(25/25).No conversion to laparotomy was required .No surgical complications occurred . Follow-up for 6 -48 months ( median, 30 months ) in 25 cases found no signs of recurrence and metastasis .One patient died of myocardial infarction and the remaining 24 patients survived .Seven cases were performed laparoscopic-assisted endoscopic surgery , including laparoscopic-assisted endoscopic submucosal dissection colon ( ESD) in 3 cases, laparoscopic-assisted endoscopic mucosal resection ( EMR) in 2 cases, and laparoscopic-assisted endoscopic polypectomy in 2 cases.Intestinal perforation occurred during the operation in 1 case of ESD, which was given a laparoscopic colon perforation repair .Follow-up for 9 -36 months ( median, 24 months) in 7 cases showed no deaths or signs of recurrence and metastasis . Conclusion Combined laparoscopic-endoscopic procedure has advantages of both laparoscopy and endoscopy to improve surgical safety , on the basis of good cooperation of laparoscopic and endoscopic teams .