腹腔镜、结肠镜联合手术治疗结直肠小病灶(直径≤3.5cm)肿瘤  

Clinical Application of Laparoscopy Combined with Colonoscopy in the Treatment of Small Lesions(Diameter≤3.5cm) of Colorectal Tumors

作　　者：任宝军[1] 陈小伍[1] 朱达坚[1] 剧永乐[1] 陆光生[1] 冯家立[1] 耿岩[1] 欧阳满照[1] 

机构地区：[1]南方医科大学附属顺德第一人民医院胃肠胰疝外科,顺德528300

出　　处：《中国微创外科杂志》2016年第8期740-742,751,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：佛山市医学类科技攻关项目(201208223)

摘　　要：目的探讨腹腔镜、结肠镜双镜联合加术中快速冰冻病理检查在结直肠小病灶(直径≤3.5 cm)肿瘤治疗中的临床应用价值。方法回顾性分析我院2012年5月~2015年4月应用腹腔镜、结肠镜联合加术中快速冰冻病理检查治疗结直肠小病灶肿瘤36例的临床资料。肿瘤位于直肠3例,乙状结肠9例,降结肠11例,横结肠4例,升结肠9例。肿瘤大小1.0 cm×1.5 cm^3.5 cm×3.5 cm。腹腔镜、结肠镜联合精确定位肿瘤位置后,腹腔镜下切除肿瘤送全瘤术中冰冻病理检查,根据冰冻病理结果腹腔镜下完成肠切除术或肠癌根治术。结果 36例手术均获得成功。3例术前局部活检病理示绒毛状腺瘤伴重度非典型增生,术中快速冰冻病理检查全瘤活检示腺癌。17例管状绒毛状腺瘤伴轻度(9例)或中度(8例)非典型增生行肠壁并息肉楔形切除术,5例管状绒毛状腺瘤伴轻度(2例)或中度(3例)非典型增生及3例绒毛状腺瘤伴重度非典型增生行部分肠管切除术,2例绒毛状腺瘤伴重度非典型增生行肠管切除加局域淋巴结清扫术,9例腺癌行肠癌根治术。无术后吻合口出血、吻合口狭窄、吻合口漏、腹腔内感染。术后随访6~36个月,平均20.5月,未发现肿瘤复发、远处转移及切口种植。结论应用腹腔镜、结肠镜双镜联合加术中快速冰冻病理检查治疗结直肠小病灶肿瘤安全,高效,微创。Objective To investigate the value of combined use of laparoscopy and colonoscopy and intraoperative frozen section for treating small lesions of colorectal tumors. Methods Clinical data of 36 patients with small lesions of colorectal tumors（ diameter ≤ 3. 5 cm）,who received laparoscopy combined with colonoscopy and intraoperative frozen section between May 2012 and April 2015,were analyzed retrospectively. The tumors were located in the rectum（ 3 cases）,sigmoid colon（ 9 cases）,descending colon（ 11 cases）,transverse colon（ 4 cases）,and ascending colon（ 9 cases）,respectively. The tumor size was from 1. 0 cm × 1. 5cm to 3. 5 cm × 3. 5 cm. Tumors were resected laparoscopically after accurate positioning by laparoscopy combined with colonoscopy.Then the complete tumor was send for intraoperative frozen section examination. Laparoscopic enterectomy or radical resection was performed after determining the scope of the surgery according to the frozen pathological results. Results The operation was performed successfully in all the 36 cases. Three cases of villous adenoma with severe atypical hyperplasia were diagnosed as adenocarcinoma by intraoperative frozen section. Seventeen cases of tubulovillous adenoma with mild（ 9 cases） or moderate（ 8 cases）atypical hyperplasia were treated by laparoscopic wedge resection. Five cases of tubulovillous adenoma with mild（ 2 cases） or moderate（ 3 cases） atypical hyperplasia and 3 cases of villous adenoma with severe atypical hyperplasia underwent segment resection. Two cases of villous adenoma with severe atypical hyperplasia and 9 cases of adenocarcinoma received segment resection and dissection of lymph node or radical resection. None of them had anastomotic bleeding,stenosis,leakage or intra-abdominal infection. The follow-up period ranged 6- 36 months（ mean,20. 5 months）. No recurrent tumor,distant metastasis or implanted metastatic lesions on the abdominal wall was seen during the period. Conclusion Application of laparoscopy com

关 键 词：腹腔镜 结肠镜 结直肠肿瘤 小病灶 术中快速冰冻病理检查 

分 类 号：R735.3[医药卫生—肿瘤]