摘要
目的探讨腹腔镜联合结肠镜治疗结直肠小占位(≤3 cm)病变的临床效果。方法 2010年1月~2015年1月我院采用腹腔镜联合结肠镜手术治疗小占位结直肠肿瘤41例,结肠镜进行全结直肠内探查,在结肠镜下注射亚甲蓝进行染色,腹腔镜下进行局部钛夹定位,退出结肠镜,术中根据快速冰冻病理结果选择在腹腔镜下肠管切除、结直肠根治术等相应手术。结果 41例均顺利完成腹腔镜联合结肠镜手术,无中转开腹。9例术前诊断为癌前病变,术中及术后病理诊断为结肠上皮内瘤变6例,Tis期腺癌3例。32例术前诊断为0~Ⅰ期结直肠癌者,术中及术后诊断Ⅰ期29例,其中T_1N_0M_0期腺癌23例,T_2N_0M_0期腺癌6例;Ⅲ期3例,均为T_2N_1M_0期腺癌。多发病灶2例。结肠上皮内瘤变及Tis期结直肠肠癌行病变肠管切除,T_1~T_2期结直肠癌均行结直肠癌根治术。2例结肠上皮瘤变分别在术后9、12个月随访无复发。其余39例随访24~49个月,中位时间38.6月,35例结直肠癌中,1例T_2N_1M_0即Ⅲ期腺癌术后34个月结肠镜复查局部复发,所有患者均无转移。结论腹腔镜联合结肠镜治疗≤3 cm良性及Tis^T_2期恶性结直肠肿瘤,可发挥双镜优势,尤其适用于单镜难以定位或完全切除的病变,可提高定位精确性及手术安全性。
Objective To evaluate the clinical efficacy of laparoscopy combined with colonoscopy for small colorectal space occupying lesions（ equal or less than 3 cm）. Methods From January 2010 to January 2015,a total of 41 cases of small colorectal space occupying lesions（ equal or less than 3 cm） were treated under general anesthesia with laparoscopic surgery combined with colonoscopy. The patients were placed at the lithotomy position. After the establishment of pneumoperitoneum,injection of methylene blue for staining was carried out under colonoscopy. Laparoscopic titanium clipping positioning was conducted, and then the colonoscope was withdrawn. According to the intraoperative frozen pathological results,bowel resection surgery or colorectal surgical resection was selected. Results All the 41 cases of laparoscopic combined with colonoscopic surgery were successfully completed,with no conversion to laparotomy. There were 9 cases of preoperative diagnosis of precancerous lesions,6 of which were found neoplasia in the colon epithelium with intraoperative pathological diagnosis,with 3 cases of Tis adenocarcinoma. Among 32 cases of preoperative diagnosis of stage 0- Ⅰ colorectal cancer,there were 29 cases of intraoperative and postoperative diagnosis of stage Ⅰ（ 23 cases of T_1N_0M_0 adenocarcinoma and 6 cases of T2N_0M_0adenocarcinoma） and 3 cases of stage Ⅲ（ T_2N_1M_0adenocarcinoma）. Two cases were multiple lesions. Bowel resection was performed in colon intraepithelial neoplasia and Tis lesions of colorectal cancer,while resection of colorectal cancer was conducted in stage T_1- T2 colorectal cancer. Two patients with colonic epithelial neoplasia were followed up for 9and 12 months,without recurrence. The remaining 39 cases were followed up for 24- 49 months,with a median of 38. 6 months.Among the 35 cases of colorectal cancer,colonoscopy detected local recurrence in 1 case of T_2N_1M_0adenocarcinoma（ stage Ⅲ） after 34 postoperative months. No metastasis was found in all the patients. Conclu
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第5期418-420,435,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
结直肠癌
腹腔镜手术
结肠镜手术
Colorectal cancer
Laparoscopic surgery
Colonoscopy surgery
