腹腔镜直肠癌前切除术472例临床经验总结

发布时间：2018-04-28 02:49

本文选题：直肠癌 + 前切除术　；参考：《中国微创外科杂志》2015年03期

【摘要】：目的探讨腹腔镜直肠癌前切除术的手术技巧、经验及疗效。方法回顾性分析2006年4月~2012年10月我院腹腔镜直肠癌前切除术472例的临床资料及手术视频,手术遵循全系膜切除(total mesorectal excision,TME)原则及无瘤技术常规,从中间入路进行解剖游离,采用双吻合器技术进行消化道重建。结果 1 425例成功完成腹腔镜手术,手术时间62~238 min,平均119 min,术中出血15~320 ml,平均62.5 ml。2淋巴结清扫数7~41枚,平均19枚,均行肠系膜下动静脉根部结扎离断。直肠癌手术标本评估3级379例(89.2%),2级46例(10.8%)。3 47例中转开腹,其中22例是由于手术成员变化而造成的配合生疏及暴露不清,3例盆腔粘连,13例出血无法控制,9例病期较晚与术前评估不符。4无手术死亡病例,术后并发症37例(8.7%),包括吻合口出血5例,吻合口漏9例,切口感染14例,切口疝9例。5 332例完成腹腔镜手术者随访24~102个月,平均58个月。1年、3年、5年生存率分别为99.7%、90.3%和79.1%。结论腹腔镜直肠癌前切除术应注意关键步骤的把握,骶前及直肠周围的游离技巧是保证系膜完整切除的关键,保证标本切除和取出的完整性。术前应严格控制适应证,减少中转开腹率。强调团队配合,减少助手、持镜医师、护士甚至麻醉师的频繁更替。
[Abstract]:Objective to explore the operative technique, experience and curative effect of laparoscopic anterior resection of rectal cancer. Methods from April 2006 to October 2012, the clinical data and operation video of 472 cases of anterior laparoscopic resection of rectal cancer in our hospital were retrospectively analyzed. Double stapling technique was used to reconstruct digestive tract. Results 1 425 cases were successfully performed laparoscopic surgery. The operative time was 622 ~ 238 min (mean 119 min). The operative bleeding was 15320 ml, and the average number of lymph node dissection was 72.5 ml.2 (741 cases, 19 cases). All the patients underwent submesenteric arteriovenous root ligation and dissection. Surgical specimens of rectal cancer were evaluated in 379 cases of grade 3 and 89.2 and 46 cases of grade 2, 10.8.3, and 47 cases were transferred to open operation. Among them, 22 cases were caused by the change of operation members and 3 cases of pelvic adhesions (13 cases) of bleeding could not be controlled, 9 cases were late to the preoperative evaluation and 4 cases of no operative death. Postoperative complications included anastomotic bleeding in 5 cases, anastomotic leakage in 9 cases, incision infection in 14 cases, incision hernia in 9 cases, laparoscopic operation in 9 cases (mean 58 months). The survival rates for 1 year, 3 years and 5 years were 99.70.3% and 79.1%, respectively. Conclusion Laparoscopic anterior resection of rectal cancer should pay attention to the key steps. The technique of presacral and perirectal dissociation is the key to ensure the complete mesentery resection and the integrity of specimen removal and removal. Preoperative indications should be strictly controlled to reduce the rate of conversion to laparotomy. Emphasis on teamwork to reduce frequent turnover of assistants, optometrists, nurses and even anesthesiologists.
【作者单位】：辽宁省肿瘤医院大肠外科;辽宁省肿瘤医院手术室;
【分类号】：R735.37

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