3D腹腔镜经腹会阴联合切除术流程改良与体会  

Improvement and experience of 3D laparoscopic abdominoperineal resection process

作　　者：卢义康 刘洪洲[1] 洪绍忠 吕彦东[1] Lu Yikang;Liu Hongzhou;Hong Shaozhong;Lyu Yandong(Department of Colorectal Surgery,Peace Hospital Affiliated to Changzhi Medical College,Changzhi 046000,China)

机构地区：[1]长治医学院附属和平医院结直肠外科,046000

出　　处：《中华普通外科学文献（电子版）》2021年第2期116-119,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：山西省服务产业创新学科群建设计划项目(201809)。

摘　　要：目的探讨3D腹腔镜经腹会阴联合切除术(APR)的科学流程及相关体会。方法回顾性分析长治医学院附属和平医院2016年1月至2018年10月成功行3D腹腔镜APR手术的90例低位直肠癌患者资料。对APR手术流程进行改良:会阴部手术开始于游离直肠后间隙;会阴部与腹部相通时至完整游离切除标本的时间段,与在开始做造口切口时至完成腹膜外造口第Ⅱ步的时间段一致;重建盆底腹膜其后1/3部分+腹膜外造口第Ⅲ步与会阴部的缝合将同步进行完成。结果无中转开腹手术,术中出血量为(120.4±41.6)ml,手术时间(165.7±30.5)min。术后首次排气时间为2(1~6)d,住院时间为(14.5±2.3)d;发生切口感染3例,肠粘连和造口旁疝各1例,尿潴留5例,造口水肿1例。90例行3D腹腔镜APR手术患者全部治愈,随访8(6~14)个月,无局部复发和远处转移。结论掌握3D腹腔镜APR手术的科学流程,使得腹部与会阴部协调统一,有助于缩短手术时间,增加手术安全性。Objective To explore the scientific process and related experience of 3D laparoscopic abdominoperineal resection (APR) surgery.Methods A retrospective analysis was carried out of ninety patients who successfully underwent 3D laparoscopic APR from January 2016 to October 2018 in the Peace Hospital Affiliated to Changzhi Medical College.The procedure of APR was improved:(1) Perineal surgery started by freeing the posterior rectal space.(2) The period from the time when the perineum communicated with the abdomen to the complete free excision of the specimen was the same the time period as stoma incision to the completion of the step Ⅱ of the extraperitoneal stoma.(3) Rebuild the posterior 1/3 of the pelvic peritoneum + extraperitoneal stoma step Ⅲ and the suture of the perineum completed simultaneously.Results There was no conversion to open surgery.The intraoperative blood loss was (120.4±41.6) ml and the operation time was (165.7±30.5) min.The first exhaust time was 2 days (1-6 days),and the hospital stay was (14.5±2.3) days.Postoperative infection occurred in three cases,intestinal adhesion in one case,para stomal hernia in one case,urinary retention in five cases,stoma slobber in one case.All the patients were cured by 3D laparoscopic APR surgery.No local recurrence or distant metastasis was found during the follow-up period of 8 (6-14) months.Conclusion It is helpful to shorten the operation time,and increase the safety to master the scientific process of 3D laparoscopic APR operation,which makes the abdomen and perineum coordinate and unify.

关 键 词：腹腔镜 直肠肿瘤 经腹会阴联合切除术 手术时间 

分 类 号：R735.34[医药卫生—肿瘤]