腹腔镜下结直肠癌根治术的临床应用研究

1、腹腔镜下结直肠癌根治术的临床应用研究             作者：陶凯雄 王国斌 卢晓明 龙跃平 蒋春舫 黄文广 周颜才 蔡开琳 韩高雄 陈道达【摘要】目的：探讨腹腔镜结直肠癌根治术的临床应用价值。方法：回顾分析例腹腔镜下结直肠癌根治术的临床病例资料，其中右半结肠切除术例、横结肠切除术例、左半结肠切除术例、乙状结肠切除术例、直肠癌行直肠前切除术例、直肠癌行结肠拖出式切除术例、iles术例、结肠次全切除术例、全结肠切除术例。结果：5例均在腹腔镜下完成，腹腔镜手术切除率（/），例中转开腹

2、行Miles术；手术时间平均min；术中出血量平均ml；术后肠蠕动恢复时间平均d；术后无出血、吻合口漏、伤口感染等并发症，例出现轻度尿潴留症状，例术后轻度性功能障碍；术后平均住院d；术后随访m；死亡人。结论：运用腹腔镜技术进行结直肠癌根治术，具有操作安全、创伤小、恢复快等特点，不仅技术上可行，而且完全可达到开腹根治术的效果。   【关键词】腹腔镜；结直肠癌；根治术   Clinical application of laparoscopic radical resection for colorectal cancers    【Ab

3、stract】bjective:To study the value of laparoscopic radical colorectomy for colorectal cancer.Methods:The clinical data of 77 patients with colorectal cancer performed laparoscopic colorectomy were analyzed retrospectively;among them，12 cases performed right hemicolectomy，2 cases by transverse colore

4、ctomy，12 cases by left hemicolorectomy，8 cases by sigmoid colorectomy，19 cases by rectal anterior resection，8 cases by parks operation，12 cases by Miles operation，2 cases by subtotal colorectomy and 2 cases by total colorectomy.Results:75 cases were performed by laparoscopic colorectomy successfully

5、,tne rate of laparoscopic excision is 97.4%,2 cases were converted to open lapotomy procedures(Miles operation);the average operative time was 175minutes;the average lose blood was 110ml;the average postoperative convalescence of intestinal peristalsis was 1.9 days;There were not operative complicat

6、ions such as hemorrhage，anastomostic leakage，wound infection;but 4 cases with mild retention of urine，6 cases with mild sexual dysfunction;the mean hospital stay was 7.5 days;the followup period ranged from 2 to 42 months,2 cases died of tumor metastasis.Conclusions:The laparoscopic radically 

7、colorectomy for colorectal cancer is not only technologically feasible and safe with less trauma，pain and rapid recovery,but also completely effective comparing to the open colorectomy.   【Key words】Laparoscopy;Colorectal cancer;Radical resection   自从二十世纪八十年代末腹腔镜胆囊切除术（Laparoscopi

8、c Cholecystectomy，LC）问世以来，腹腔镜技术以其微创、美容、恢复快等特点普遍开展起来；几乎在与此同时的九十年代初期，人们就已经开始尝试将腹腔镜技术运用于传统的结直肠外科手术并取得了成功；由此，开始了微创结直肠外科手术的新纪元。我院2000年12月2004年10月开展腹腔镜下结直肠肿瘤切除术77例，取得了较满意的疗效，现报道如下。   1资料与方法   1.1临床资料本组77例，男46例，女31例，2791岁，平均55岁；回盲部肿瘤7例、结肠肝曲肿瘤5例、横结肠肿瘤例、结肠脾曲肿瘤5例、降结肠肿瘤7例、乙状结肠癌8例、中上段直肠癌7例（距

9、肛缘7cm）、低位直肠癌12例（距肛缘57cm）、超低位直肠息肉癌变8例（息肉距肛缘5cm）、直肠肛管癌12例、溃疡性结肠炎癌变例、结直肠多发性腺瘤样息肉癌变1例、多发性结直肠炎并狭窄1例。病理类型：高分化腺癌11例、中低分化管状腺癌26例、低分化腺癌18例、未分化癌5例、粘液腺癌8例、鳞状细胞癌3例，腺瘤癌变4例。Dukes分期A期14例、期32例、C期28例（C期16例、C2期12例）、D期3例。   1.手术方法麻醉及体位：术前准备与常规开放手术相同；所有患者均采用气管插管全身麻醉方式；体位根据手术方式不同取头低足高并右侧倾斜的仰卧或改良截石位（左半结肠、乙状结肠及直

10、肠癌切除术）、左侧倾斜平卧位（右半结肠切除术）、头高足低仰卧位（横结肠切除术）等；人工气腹压力设置在1015mm Hg之间，脐部10mm观察孔置入腹腔镜，其余穿刺孔的设置视手术方式而定；一般3个cm穿刺孔，或做35cm的辅助切口供标本取出。手术方法：根据病灶位置决定不同的手术方式，但共同的操作步骤包括，脐部Trocar置入30°腹腔镜常规全腹腔探查，明确有无腹腔脏器转移或腹膜种植灶；肿瘤是否侵犯肠壁浆膜；结合术中纤维结肠镜对肿瘤进一步定位诊断，及是否存在结直肠多原发癌；术中的无瘤操作技术及术中化疗原则，术毕无菌蒸馏水或生理盐水加或不加化疗药物（Fu、等）2 0003 000ml冲洗腹

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