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目的探讨腹部无切口腹腔镜低位直肠癌根治经肛门切除标本吻合器腹壁结肠造口术的安全性、可行性及临床疗效。方法回顾性分析2010年1月至2016年12月低位或超低位直肠癌施行腹部无切口经肛门切除标本的腹腔镜直肠癌根治吻合器腹部结肠造口术106例(含外院9例)临床资料,其中男59例,女47例,年龄34~87岁,平均(60.7±19.8)岁。肿瘤距肛缘2~5 cm。术前评估T1-2N0M065例,T2N1-2M041例,术后患者采取早期活动渐进4步活动法。结果本组106例手术,无中转开腹手术,经过顺利均获成功。手术时间平均时间为(149±17.7)min,术中平均出血量为(50±16.9)ml,术后2~3 d肠蠕动恢复,腹部结肠造口排气,3~4 d下床活动,术后平均12 d患者出院.。术后病理为T1-2N0M027例,T2-3N1-3M079例。会阴部切口愈合良好。腹部结肠造口无肠管坏死、回缩等并发症,早期病例发生粘连性肠梗阻2例(1.8%),给予胃肠减压、中药等保守治疗梗阻解除。术后随访3~73个月,有3例(2.8%)结肠造口狭窄,行再次造口修复手术。术后3年局部肿瘤复发4例(3.7%)。结论腹部无切口的腹腔镜低位直肠癌根治经肛切除吻合器腹壁结肠造口术,是安全可行,真正达到腹部无手术切口、无瘢痕、美容美观、完全微创的最佳效果,临床疗效满意。
Objective To investigate the safety, feasibility and clinical efficacy of abdominal resection laparoscopic low rectal cancer radical mastectomy abdominal colostomy. Methods The clinical data of 106 cases (including 9 outpatients) of laparoscopic radical resection of laparoscopic resection of colorectal stoma by abdominal incision and rectal resection for low or ultra-low rectal cancer from January 2010 to December 2016 were retrospectively analyzed. , Of which 59 males and 47 females, aged 34 to 87 years (mean, 60.7 ± 19.8 years). Tumors from the verge of 2 ~ 5 cm. Preoperative evaluation of T1-2N0M065 cases, T2N1-2M041 cases, postoperative patients take early activity progressive 4-step activity. Results The group of 106 cases of surgery, no transit laparotomy, after successful were successful. The average operation time was (149 ± 17.7) min, mean intraoperative blood loss was (50 ± 16.9) ml, postoperative recovery of peristalsis was 2 ~ 3 days, abdominal colostomy, 3 ~ 4 days of ambulation, Patients were discharged after 12 days on average. Postoperative pathology T1-2N0M027 cases, T2-3N1-3M079 cases. Perineal incision healed well. Abdominal colostomy without bowel necrosis, retraction and other complications, early cases of adhesive intestinal obstruction occurred in 2 cases (1.8%), given gastrointestinal decompression, traditional Chinese medicine and other conservative treatment of obstruction relieve. All the patients were followed up for 3 to 73 months. Three patients (2.8%) had colostomy stenosis. The patients underwent re-stoma repair surgery. Three years after the local tumor recurrence in 4 cases (3.7%). Conclusion Abdominal incision laparoscopic surgery of low rectal cancer by anal resection stapler abdominal wall colostomy, is safe and feasible, truly no abdominal incision, no scars, cosmetic, complete minimally invasive best effect, clinical efficacy satisfactory .