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目的探讨腹腔镜结直肠癌根治术的近期疗效及并发症。方法回顾性分析2012年7月至2014年6月,昆明市第一人民医院普外科施行的54例腹腔镜辅助结直肠癌根治术的临床资料。其中直肠癌行Dixon术27例,右半结肠切除术12例,Miles术8例,乙状结肠切除术4例,左半结肠切除术3例。结果除外2例中转开腹,其余52例均在腹腔镜辅助下顺利完成手术,无手术死亡病例;结肠癌切除包括肿块在内的11~26 cm肠管;直肠癌行Dixon术或Miles术时,下端切缘距肿瘤下缘1~3 cm,术中冰冻及术后病理证实所有标本残端均无肿瘤细胞残留、浸润。手术时间112~325 min,平均手术时间186 min;术中出血30~400 ml,平均术中出血120 ml;术后排气时间36~72 h,平均术后排气时间48 h;淋巴结清扫9~21枚,平均淋巴结清扫14.5枚。术后无出血、吻合口狭窄等并发症发生;2例会阴部切口感染,经过换药后痊愈;1例术后2 d因吻合口瘘再次开腹造瘘,1例造瘘口肠坏死回缩,5个月后经原造瘘口再次造瘘术;1例Dixon术后附加小肠造瘘口肠套叠麻醉后手法复位。术后住院时间9~28 d,平均术后住院时间15.2 d。术后电话随访至2015年3月。电话随访期内,死亡2例;局部复发2例;肝转移1例;1例再发肠梗阻行复发肿瘤切除,回肠造瘘;1例Miles术后闭孔内肌旁复发,再次经肛肿瘤切除术;其余均未发现转移、复发及切口种植。结论腹腔镜辅助结直肠癌根治术具有患者创伤小、出血少,操作安全、术后并发症少等优点,可取得与传统开腹手术媲美的治疗效果。
Objective To investigate the short-term efficacy and complications of laparoscopic radical resection of colorectal cancer. Methods The clinical data of 54 patients undergoing laparoscopic radical colorectal cancer radical surgery from July 2012 to June 2014 in Kunming First People’s Hospital were analyzed retrospectively. Among them, 27 patients underwent Dixon’s surgery, 12 patients underwent right hemicolectomy, 8 patients underwent Miles operation, 4 patients underwent sigmoid colon resection and 3 patients underwent left-half colon resection. Results Exclusion of 2 cases converted to open surgery, the remaining 52 cases were successfully laparoscopic assisted surgery without surgical death cases; colon cancer resection including lumps, including 11 ~ 26cm intestinal; Dixon or Miles surgery for rectal cancer, The lower edge of the margin from the lower edge of the tumor 1 ~ 3 cm, intraoperative frozen and postoperative pathology confirmed the stump of all specimens without residual tumor cells, infiltration. The operative time was 112-325 min with an average operation time of 186 min. The intraoperative bleeding was 30-400 ml with an average blood loss of 120 ml. The postoperative exhaust time was 36-72 h, the average postoperative exhaust time was 48 h. The lymph node dissection ~ 21, the average lymph node dissection 14.5. 2 cases of perineal incision infection, cured after dressing change; 1 case 2 days after open anastomotic fistula reopening fistula, 1 case of intestinal fistula necrosis , 5 months after the original fistula re-fistulation; 1 case of Dixon operation after small intestine fistula rectal intussusception anesthesia reduction. The postoperative hospital stay was 9-28 days, with an average postoperative hospital stay of 15.2 days. Follow-up phone to March 2015. During the telephone follow-up period, there were 2 deaths, 2 local recurrences, 1 liver metastasis, 1 recurrent obstruction with recurrent tumor resection and ileum fistula, 1 muscle with paravertebral recurrence after Miles operation, Excision; the rest were not found metastasis, recurrence and incision planting. Conclusions Laparoscopic-assisted radical resection of colorectal cancer has the advantages of less trauma, less bleeding, safe operation and less postoperative complications, which can achieve the same therapeutic effect as traditional laparotomy.