摘要
目的探讨腹腔镜直肠癌根治术的手术路径及应用前景。方法回顾性分析我院2003年7月至2010年12月期间行腹腔镜直肠癌根治术的433例患者的临床资料,结合文献复习,讨论腹腔镜直肠癌根治手术的路径选择及发展前景。结果 行手助腹腔镜手术5例(1.2%),完全腹腔镜手术(Dixon手术需做左下腹小切口取出标本,Miles手术利用会阴切口取出标本)412例(95.2%),腹部免切口肛门拖出式吻合手术16例(3.7%)。中转开腹手术11例(2.5%)。290例(67.0%)患者获得随访,随访时间1～6年,平均2.7年,发现吻合口或盆腔肿瘤复发7例(2.4%),远处转移22例(7.6%),死亡46例(15.9%),无戳孔转移发生。结论四孔腹腔镜技术仍是临床应用的主流;规范化的腹腔镜直肠癌根治术是保证疗效和操作便利的前提;单孔或经自然腔道的直肠癌根治术是手术进一步微创化的探索方向。
Objective To standardize the techniques for laparoscopic radical rectal resection and discuss its application prospect.Methods The clinical data of 433 patients who underwent laparoscopic radical rectal resections from July 2003 to December 2010 in our hospital were reviewed retrospectively,and the different surgery procedures and the development prospect were explored.Results Five cases（1.2%） underwent hand-assistant laparoscopic procedures,412 cases（95.2%） were done by laparoscopic-assisted operation,and the specimens were taken out with transanal pull-through technique in 16 cases（3.7%）.In all of them,conversion to open procedures occurred in 11 patients（2.5%）,and 290（67.0%） patients were followed-up in 1 to 6 years,average in 2.7 years.Local recurrence occurred in 7（2.4%） patients,while distant metastasis were diagnosed in 22（7.6%） cases,and the overall mortality was 15.9%（46/290）.There was no port-site metastasis occurred.Conclusions Four-port laparoscopic rectal resection technique is also the clinical mainstream.Standardized laparoscopic procedure for rectal resections enhances the transformation of laparoscopic skills,and makes the operation predictable.Single incision procedure and natural orifice transluminal endoscopic surgery are future direction to explore.
出处
《中国普外基础与临床杂志》
CAS
2011年第11期1151-1154,共4页
Chinese Journal of Bases and Clinics In General Surgery
关键词
直肠癌
腹腔镜手术
规范化手术
Rectal cancer
Laparoscopic operation
Standardized surgery
