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目的探讨腹腔镜辅助下结直肠肿瘤切除术在临床应用的效果和初步经验。方法2003年2月至2008年2月运用腹腔镜技术,按开放手术原则治疗结直肠肿瘤28例,其中右半结肠切除术2例,乙状结肠切除术7例,腹会阴联合直肠切除术9例,结肠直肠肿瘤行直肠前切除术(Dixon)10例。观察并记录手术时间、出血量、并发症、肠功能恢复时间、住院时间等临床指标。结果27例腹腔镜辅助手术成功,1例为中上段巨大直肠癌侵犯膀胱后壁中转开腹手术。手术时间110～315分钟,平均156.4分钟。术中出血量40～300 ml,平均70 ml。术后20～72h胃肠功能恢复(平均32.5h),无术中大出血,术后疼痛轻、创伤小、无副损伤发生。术后住院时间(不包括化疗)7～10(平均8.1d);随访23例,时间1～18个月,平均6个月、22例未见复发转移、肿瘤复发死亡1例。结论腹腔镜辅助下结直肠肿瘤手术损伤小、安全可行,熟练的腔镜技术和手术经验有助于手术,近期临床效果满意,远期疗效有待进一步观察。
Objective To investigate the clinical effect and preliminary experience of laparoscopic-assisted colorectal tumor resection. Methods From February 2003 to February 2008, 28 cases of colorectal tumors were treated with laparoscopy according to the principle of open surgery. Among them, 2 were right-sided colon resection, 7 were sigmoid resection, 9 were perineal perineal rectal resection, Colorectal neoplasms underwent anterior resection (Dixon) in 10 cases. Observed and recorded the operation time, blood loss, complications, recovery time of intestinal function, hospital stay and other clinical indicators. Results 27 cases of laparoscopic assisted surgery was successful, 1 case of large rectal cancer invading the bladder wall conversion to laparotomy. Operation time 110 ~ 315 minutes, an average of 156.4 minutes. Intraoperative bleeding 40 ~ 300 ml, an average of 70 ml. Postoperative gastrointestinal function recovered 20 ~ 72h (average 32.5h), no intraoperative bleeding, postoperative pain, trauma, no side effects. Postoperative hospital stay (excluding chemotherapy) 7 to 10 (mean 8.1d); follow-up of 23 cases, the time of 1 to 18 months, an average of 6 months, 22 cases of recurrence and metastasis, 1 patient died of tumor recurrence. Conclusions Laparoscopic assisted colorectal tumor surgery is safe and feasible. The skilled endoscopic and operative experience is helpful to the operation. The clinical effect is satisfactory in the near future. The long-term therapeutic effect needs to be further observed.