腹腔镜辅助下直肠癌根治术(附58例报告)  

Clinical application of laparoscopic-assisted radical resection of rectal carcinoma(Report of 58 cases)

作　　者：胡斌[1] 邓剑[1] 傅正才[1] 倪新建[1] 丁志平[1] 

机构地区：[1]广东省博罗县人民医院外一科,广东博罗516100

出　　处：《岭南现代临床外科》2013年第4期332-334,共3页Lingnan Modern Clinics in Surgery

基　　金：市县拔尖人才专项资金项目资助15万元(2012B010006009)

摘　　要：目的探讨腹腔镜辅助下直肠癌根治术的临床应用价值及可行性。方法取下腹正中切口,长约6cm,利用双视腹腔镜设备,采取直视和屏视相结合,发挥直视和腹腔镜操作优势互补的作用,完成直肠癌根治术58例。结果 58例均在双视腹腔镜手术设备辅助下完成手术,L-Dixon手术49例,L-Miles手术9例。2例患者出现吻合口漏,其中1例由于炎症局限通过引流和保守治疗后恢复。另一例吻合并发盆腔腹腔经行横结肠造瘘及腹腔引流后治愈。43例患者获6个月至3年随访,平均18个月,恢复良好。1例患者25个月发现肝脏转移再次入院行肝脏部分切除。另1例患者手术后19个月肿瘤复发及多处转移,患者放弃治疗。结论应用双视腹腔镜设备辅助下行直肠癌根治术具有手术视野明亮、解剖精细、安全系数高、创伤小、恢复快、技术易于掌握等特点,有广阔的应用前景。Objective To investigate the therapeutic effect and feasibility of double-view laparoscopic-assisted radical resection for patients with rectal cancer.Methods Fifty-eight patients with rectal cancer received radical resection with a lower abdominal midline incision 6 cm in length using double-view laparoscope,which combined direct vision and screen vision so that the advantage of direct vision and laparoscopic operation could be complementary.Results Double-view laparoscopicassisted operations were successfully completed in all patients..Among them,.49 cases underwent LDixon method and 9 cases undervwnt L-Miles＇ method.Anastomotic leakage was found in 2 patients and the two patiens cured by colostomy plus abdominal drainage and conservative treatment plus abdominal drainage respectively and conservative treatment.Fourty-three of 58 cases were followed up for 6-36 months（mean,18 months）,Most of patients had good recovery.Liver metastasis was found in one case and underwent partial liver resection 25 months after surgery.One case was found the local recurrence and multi-metastasis 19 months after operation,but this patient gave up treatment by himself.Conclusion Double-view laparoscopic-assisted radical resection for patients with rectal cancer has definite advantages over traditional laparotomy,such as brighter operative field,more precise anatomy,techneque easier to control,less trauma and rapid recovery.

关 键 词：腹腔镜 微创 直肠癌 根治术 

分 类 号：R657.1[医药卫生—外科学]