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目的探讨腹腔镜全直肠系膜切除术的操作要点。方法收集2008年8月-2011年8月期间36例腹腔镜全直肠系膜切除术的临床资料,对其手术规律和经验进行总结分析,进而归纳出操作要点。结果 36例接受腹腔镜全直肠系膜切除术的患者,除1例中转开腹外,其余均顺利完成手术,无手术死亡,无严重的手术并发症。操作中应遵循以下几点:把握适应症和禁忌症,筛选合适病例;洞悉解剖层次,避免损伤输尿管;优先处理肠系膜下血管并高位结扎,彻底清扫第三站淋巴结;保护盆腔自主神经,提高术后生活质量;于正确层面进行锐性分离,避免直肠破损及致命性大出血;严格遵循无瘤原则,行全结肠系膜切除并准确定位肿瘤下切缘。结论正确理解和掌握其操作要点对顺利开展腹腔镜直肠癌手术至关重要。
Objective To investigate the main points of laparoscopic total mesorectal excision. Methods The clinical data of 36 cases of laparoscopic total mesorectal excision from August 2008 to August 2011 were collected, and the operation rules and experiences were summarized and analyzed. The main points of operation were summarized. Results Of the 36 patients undergoing laparoscopic total mesorectal excision, none of the patients undergoing laparoscopic total mesorectal excision successfully completed the operation without any surgical complications and no serious complications. The operation should follow the following points: to identify indications and contraindications, screening the appropriate cases; insight into the anatomical level, to avoid damage to the ureter; priority treatment of the mesenteric vessels and high ligation, and thorough cleaning of the third station lymph nodes; pelvic autonomic nerve protection After the quality of life; in the right level of sharp separation, to avoid rectal damage and fatal bleeding; strict accordance with the principle of tumor-free line of the whole mesocolon resection and accurate positioning of the tumor under the margin. Conclusion Correct understanding and mastery of the key points of its operation is essential for the successful operation of laparoscopic rectal cancer.