腹腔鏡下結(jié)直腸癌根治術(shù)的臨床應(yīng)用研究

1、腹腔鏡下結(jié)直腸癌根治術(shù)的臨床應(yīng)用研究             作者：陶凱雄 王國斌 盧曉明 龍躍平 蔣春舫 黃文廣 周顏才 蔡開琳 韓高雄 陳道達(dá)【摘要】目的：探討腹腔鏡結(jié)直腸癌根治術(shù)的臨床應(yīng)用價值。方法：回顧分析例腹腔鏡下結(jié)直腸癌根治術(shù)的臨床病例資料，其中右半結(jié)腸切除術(shù)例、橫結(jié)腸切除術(shù)例、左半結(jié)腸切除術(shù)例、乙狀結(jié)腸切除術(shù)例、直腸癌行直腸前切除術(shù)例、直腸癌行結(jié)腸拖出式切除術(shù)例、iles術(shù)例、結(jié)腸次全切除術(shù)例、全結(jié)腸切除術(shù)例。結(jié)果：5例均在腹腔鏡下完成，腹腔鏡手術(shù)切除率（/），例中轉(zhuǎn)開腹

2、行Miles術(shù)；手術(shù)時間平均min；術(shù)中出血量平均ml；術(shù)后腸蠕動恢復(fù)時間平均d；術(shù)后無出血、吻合口漏、傷口感染等并發(fā)癥，例出現(xiàn)輕度尿潴留癥狀，例術(shù)后輕度性功能障礙；術(shù)后平均住院d；術(shù)后隨訪m；死亡人。結(jié)論：運用腹腔鏡技術(shù)進(jìn)行結(jié)直腸癌根治術(shù)，具有操作安全、創(chuàng)傷小、恢復(fù)快等特點，不僅技術(shù)上可行，而且完全可達(dá)到開腹根治術(shù)的效果。   【關(guān)鍵詞】腹腔鏡；結(jié)直腸癌；根治術(shù)   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   自從二十世紀(jì)八十年代末腹腔鏡膽囊切除術(shù)（Laparoscopi

8、c Cholecystectomy，LC）問世以來，腹腔鏡技術(shù)以其微創(chuàng)、美容、恢復(fù)快等特點普遍開展起來；幾乎在與此同時的九十年代初期，人們就已經(jīng)開始嘗試將腹腔鏡技術(shù)運用于傳統(tǒng)的結(jié)直腸外科手術(shù)并取得了成功；由此，開始了微創(chuàng)結(jié)直腸外科手術(shù)的新紀(jì)元。我院2000年12月2004年10月開展腹腔鏡下結(jié)直腸腫瘤切除術(shù)77例，取得了較滿意的療效，現(xiàn)報道如下。   1資料與方法   1.1臨床資料本組77例，男46例，女31例，2791歲，平均55歲；回盲部腫瘤7例、結(jié)腸肝曲腫瘤5例、橫結(jié)腸腫瘤例、結(jié)腸脾曲腫瘤5例、降結(jié)腸腫瘤7例、乙狀結(jié)腸癌8例、中上段直腸癌7例（距

9、肛緣7cm）、低位直腸癌12例（距肛緣57cm）、超低位直腸息肉癌變8例（息肉距肛緣5cm）、直腸肛管癌12例、潰瘍性結(jié)腸炎癌變例、結(jié)直腸多發(fā)性腺瘤樣息肉癌變1例、多發(fā)性結(jié)直腸炎并狹窄1例。病理類型：高分化腺癌11例、中低分化管狀腺癌26例、低分化腺癌18例、未分化癌5例、粘液腺癌8例、鱗狀細(xì)胞癌3例，腺瘤癌變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.手術(shù)方法麻醉及體位：術(shù)前準(zhǔn)備與常規(guī)開放手術(shù)相同；所有患者均采用氣管插管全身麻醉方式；體位根據(jù)手術(shù)方式不同取頭低足高并右側(cè)傾斜的仰臥或改良截石位（左半結(jié)腸、乙狀結(jié)腸及直

10、腸癌切除術(shù)）、左側(cè)傾斜平臥位（右半結(jié)腸切除術(shù)）、頭高足低仰臥位（橫結(jié)腸切除術(shù)）等；人工氣腹壓力設(shè)置在1015mm Hg之間，臍部10mm觀察孔置入腹腔鏡，其余穿刺孔的設(shè)置視手術(shù)方式而定；一般3個cm穿刺孔，或做35cm的輔助切口供標(biāo)本取出。手術(shù)方法：根據(jù)病灶位置決定不同的手術(shù)方式，但共同的操作步驟包括，臍部Trocar置入30°腹腔鏡常規(guī)全腹腔探查，明確有無腹腔臟器轉(zhuǎn)移或腹膜種植灶；腫瘤是否侵犯腸壁漿膜；結(jié)合術(shù)中纖維結(jié)腸鏡對腫瘤進(jìn)一步定位診斷，及是否存在結(jié)直腸多原發(fā)癌；術(shù)中的無瘤操作技術(shù)及術(shù)中化療原則，術(shù)畢無菌蒸餾水或生理鹽水加或不加化療藥物（Fu、等）2 0003 000ml沖洗腹

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