摘要
目的探讨腹部无切口腹腔镜低位直肠癌根治经肛门切除标本吻合器腹壁结肠造口术的安全性、可行性及临床疗效。方法回顾性分析2010年1月至2016年12月低位或超低位直肠癌施行腹部无切口经肛门切除标本的腹腔镜直肠癌根治吻合器腹部结肠造口术106例(含外院9例)临床资料,其中男59例,女47例,年龄34~87岁,平均(60.7±19.8)岁。肿瘤距肛缘2~5 cm。术前评估T1-2N0M065例,T2N1-2M041例,术后患者采取早期活动渐进4步活动法。结果本组106例手术,无中转开腹手术,经过顺利均获成功。手术时间平均时间为(149±17.7)min,术中平均出血量为(50±16.9)ml,术后2~3 d肠蠕动恢复,腹部结肠造口排气,3~4 d下床活动,术后平均12 d患者出院.。术后病理为T1-2N0M027例,T2-3N1-3M079例。会阴部切口愈合良好。腹部结肠造口无肠管坏死、回缩等并发症,早期病例发生粘连性肠梗阻2例(1.8%),给予胃肠减压、中药等保守治疗梗阻解除。术后随访3~73个月,有3例(2.8%)结肠造口狭窄,行再次造口修复手术。术后3年局部肿瘤复发4例(3.7%)。结论腹部无切口的腹腔镜低位直肠癌根治经肛切除吻合器腹壁结肠造口术,是安全可行,真正达到腹部无手术切口、无瘢痕、美容美观、完全微创的最佳效果,临床疗效满意。
Objective To investigate the safety,feasibility and clinical outcome of laparoscopic abdominal peritoneal resection（APR） and colostomy by using stapler without abdominal incision for low rectal cancer. Methods From Jan 2010 to Dec 2016,106 patients with low or ultralow rectal cancers,including 59 males and 47 females with an average age of 60. 7 years（ranging from 34 to 87 years）underwent laparoscopic APR and colostomy by using stapler without abdominal incision. The distance between the anus and inferior margin of the tumor ranged from 2 cm to 5 cm. TNM staging showed that65 patients had c T1-2N0M0 staging,41 had c T2N1-2M0 staging. Clinical data of 106 patients were analyzed retrospectively. Results All of 106 patients received successful laparoscopic surgery without conversion.The average operation time was 149 min. The average intraoperative blood loss was 50 ml. Bowel movement recovered 2-3 days after surgery. The first postoperative ambulation ranged from 3 to 4 days. Average postoperative hospital stay was 12 days. Postoperative pathological results showed that 27 patients had p T1-2N0M0 staging,79 had p T2-3N1-3M0 staging. There were no postoperative complication such as delayed incision heal,stoma necrosis or retraction. There were 2 cases（1. 8%） of early postoperative inflammatory small bowel obstruction,who were cured by gastrointestinal decompression and traditional Chinese medicine treatment. The postoperative follow-up ranged from 3 to 73 months,with 3 cases（2. 8%） of stoma stenosis who received reconstructive surgery. There were 4 cases（3. 7%） of local recurrence within 3 years after surgery. Conclusion Laparoscopic abdominal peritoneal resection（APR） and colostomy by using stapler without abdominal incision for low rectal cancer is safe,reliable and mini-invasive,without incision and scar on the abdominal wall with satisfactory clinical outcome.
出处
《中华普外科手术学杂志（电子版）》
2017年第4期292-294,共3页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
国家自然科学基金项目(30772118
30471700
81041025)~~
关键词
直肠肿瘤
腹腔镜检查
外科手术
微创性
Rectal neoplasms
Laparoscopy
Surgical procedures
minimally invasive
