论文部分内容阅读
目的:探讨腹腔镜结直肠癌手术后早期再次手术的原因及方式。方法:对我院胃肠外科在1999年7月至2012年6月间的1869例接受腹腔镜手术治疗结直肠癌的患者临床资料进行回顾性分析。包括右半结肠切除术271例,横结肠切除术41例,左半结肠切除术105例,乙状结肠切除术303例,全结肠切除术13例,直肠前切除术908例,腹会阴切除术214例,Hartmann术14例。结果:有30例患者于术后早期(1个月内)因并发症行再次手术治疗,原因包括吻合口漏10例、肠梗阻6例、戳孔疝6例、腹腔出血(左直肠中动脉出血)1例、吻合口出血1例、结肠造口坏死1例、预防性回肠造口脱垂并嵌顿1例、造口旁疝1例、回肠阴道瘘1例、输尿管断裂1例、辅助切口裂开1例。再次手术距原结直肠癌手术时间平均为(6.81±5.22)d。20例再次行腹腔镜手术,16例成功(80.00%,16/20),4例行腹腔镜探查后转开腹手术;9例直接行开腹手术,1例行经肛门缝扎止血。患者再次手术后平均(9.33±4.69)d康复出院。结论:腹腔镜结直肠癌手术后部分严重的并发症通过及时再次手术是可以治愈的,大部分再次手术可以再进行腹腔镜手术。
Objective: To investigate the reason and method of early reoperation after laparoscopic colorectal cancer surgery. Methods: The clinical data of 1869 patients undergoing laparoscopic surgery for colorectal cancer from July 1999 to June 2012 in our hospital were analyzed retrospectively. Including 271 cases of right hemicolectomy, 41 cases of transverse colon resection, 105 cases of left-sided colon resection, 303 cases of sigmoid resection, 13 cases of total colon resection, 908 cases of anorectal resection, 214 cases of abdominal perineal resection, Hartmann surgery in 14 cases. Results: Thirty patients were reoperated due to complications in the early postoperative period (within 1 month), including 10 cases of anastomotic leakage, 6 cases of intestinal obstruction, 6 cases of punctate hernia and 1 case of intraperitoneal hemorrhage Bleeding in 1 case, anastomotic bleeding in 1 case, colostomy necrosis in 1 case, prophylactic ileostomy prolapse and incarceration in 1 case, paravertebral hernia in 1 case, ileal vaginal fistula in 1 case, ureteral rupture in 1 case, adjuvant Incision split in 1 case. Re-operation from the original colorectal cancer surgery time averaged (6.81 ± 5.22) d. Laparoscopic surgery was performed again in 20 cases, of which 16 cases were successful (80.00%, 16/20). Laparotomy was performed in 4 cases. Laparotomy was performed in 9 cases and hemostasis was performed in 1 case. The average number of patients (9.33 ± 4.69) d after reoperation was discharged. Conclusions: Some of the serious complications after laparoscopic colorectal cancer surgery can be cured by timely reoperation, and most reoperation can be followed by laparoscopic surgery.