结肠镜及联合腹腔镜治疗结直肠腺瘤(息肉)的临床研究  

Clinical research on treating colorectal adenoma(polypus)by colonoscope combined with laparoscope

作　　者：杨德忠[1] 孙安仁[1] 张雷[1] 

机构地区：[1]重庆市中山医院,400013

出　　处：《重庆医学》2007年第11期1088-1088,1098,共2页Chongqing medicine

摘　　要：目的通过结肠镜及联合腹腔镜治疗结直肠腺瘤,探索双镜联合治疗结直肠腺瘤的适应范围、安全性和可行性。方法对我院2000年3月-2005年5月收治的188例结直肠腺瘤患者采用结肠镜或结肠镜联合腹腔镜治疗的临床资料进行回顾性分析。结果162例结直肠腺瘤内镜下切除,其中150例腺瘤直径〈2cm,12例直径〉2cm,分别行圈套电灼切或采用钛夹、尼龙圈套止血、分块切除等方法切除腺瘤。术后无肠穿孔,1例于术后7d出血,保守治疗后血止。26例分别因腺瘤无蒂且直径〉2cm或腺瘤生长部位隐匿单纯内镜治疗困难或腺瘤恶变,选择内镜联合腹腔镜治疗。其中内镜定位腹腔镜下行肠段切除20例,局部切除3例,根治性切除3例。内镜联合腹腔镜治疗术后无出血、肠穿孔及吻合口漏等并发症。本组术后有153例获得1-5年随访,其中8例复发。结论内镜联合腹腔镜治疗结直肠腺瘤可以增加内镜治疗腺瘤的适应范围和安全性,对内镜治疗困难和需要追加手术治疗的恶性病变腹腔镜是一个安全可靠的治疗手段。Objective To research the safety,feasibility and indications of treating colorectal adenoma by colonoscope combined with laparoscope. Methods The clinical data of 188 cases accepted the excision by combined colonoscope and laparoscope from March 2000 to May 2005 were retrospectively analyzed. Results One hundred and slxty-two cases succeeded by colonoscope. Among them,the diameter of adenoma 〈2cm in 150 caese and 〉2cm in 12 cases. Adenoma was excised by different methods such as loop ligature, fulguration, stopped bleeding and separated resection. There was no intestinal perforation. One case bled at 7d after operation and stopped bleeding by conservative treatment. Twenty-six cases accepted the excision by colonoscope combined with laparoscope because the adenoma was non-pedicel with the diameter〉2cm, the growth site of adenoma was concealed with difficulty of resection or adenoma had cancerous conversion. Twenty cases accepted the bowel excision,3 cases accepted the local excision and 3 cases accepted the eradicative excision. There was no haemorrhage or anastomotic stomal leak after the excision. Follow-up was performed in 153 cases for 1-5 years after operation and revealed recurrence in 8 cases. Conclusion The treatment of colorectal adenoma by combined colonoscope and laparoscope can increase the safety and indicative range of endoscopic treatment. Laparoscopy is a safe, reliable method for adenoma treated refractorily with endoscope or adenoma with cancerous conversion.

关 键 词：腹腔镜 结肠镜 腺瘤 

分 类 号：R735.3[医药卫生—肿瘤]