腹腔镜超声检查和超声刀在胃肠外科诊治中的应用

目的:探讨腹腔镜超声检查技术（LUS）和腹腔镜超声刀在腹腔镜胃肠外科手术中的应用价值。方法:对50例胃肠道肿瘤等病变采用腹腔镜超声进行前瞻性肿瘤分期诊断,结合腹腔镜超声刀开展腹腔镜胃肠手术治疗。结果:经腹腔镜和腹腔镜超声分期诊断,47例肿瘤患者均明确诊断,淋巴结穿刺活检与病理结果符合率为87.5％（7/8）;其中2例转开腹手术,6例避免了剖腹探查术,39例肿瘤患者成功地完成了腹腔镜手术。本组50例患者中42例在腹腔镜下成功完成姑息性或根治性胃肠切除术。平均手术时间190min,术中出血量平均120ml（20～250ml）,系膜淋巴结清除数平均6.5个（5～12个）,术后肠蠕动恢复时间平均36h,平均住院8.5d,无手术后并发症。术后随访3～36个月,未发现复发与转移及腹壁穿刺孔或切口转移。结论:腹腔镜胃肠手术中常规使用腹腔镜超声检查可准确为病变定位,完善肿瘤分期诊断,提高肿瘤可切除性的判断率,避免了不必要的剖腹探查;术中常规使用超声刀提高了手术安全性,扩大了腹腔镜手术范围。腹腔镜胃肠道病变切除术安全可行,近期效果良好,远期效果有待观察。腹腔镜胃肠手术将成为胃肠良恶性疾病的常规手术。

Clinical application of laparoscopic ultrasonography and harmonic scalpel in the gastrointestinal laparoscopic surgery

Objective:To study the value of laparoscopic ultrasonography(LUS)and harmonic scalpel in the gastrointestinal laparoscopic surgery. Methods: 50 patients with gastrointestinal tumors and megacolon were staged by diag nostic laparoscopy and LUS,and treated by laparoscopic surgery. Results:42 of 50 patients were successfully performed on laparoscopic operations including 39 of 47 tumor cases with 2 cases converted to open laparotomy and 6 cases avoided unnecessary laparotomy. The average operavite time was 190 min, intraoperative blood loss was 120ml, clearance amounts of mesenteric lymph nodes was 6.5(5-12), recovery time of post - op intestinal function was 36 hours, and hospital stay was 8.5 days. There were no recurrence and metastases by the follow - up of 3 ~ 36 months. Conclusions: The routine use of LUS in the gastrointestinal laparoscopic surgery optimizes the tumor staging with avoidance of unnecessary laparotomy; and the harmonic scalpel increases operative safety and expands laparoscopic operations. Laparoscopic technique is safe and efficient, and will be widely applicated in the gastro-colorectal surgery.