腹腔镜内镜联合手术治疗消化道疾病

目的探讨腹腔镜内镜联合手术的临床价值。方法总结该科3年来对13例贲门失弛缓症、1例食管下段血管瘤、1例十二指肠腺瘤、2例乙状结肠息肉和1例乙状结肠癌实施腹腔镜内镜联合手术的临床经验。该组分别实施腹腔镜内镜联合食管下段贲门肌切开、胃底折叠（Dor）13例,其中1例同时实施肝左外叶血管瘤切除、胆囊切除;腹腔镜内镜联合食管下段血管瘤切除＋食管裂孔疝修补、胃底折叠（Toupet）＋胆囊切除＋阑尾切除1例;腹腔镜内镜联合十二指肠腺瘤切除1例;腹腔镜内镜联合乙状结肠切除1例;腹腔镜内镜联合乙状结肠部分肠壁切除1例;腹腔镜内镜联合乙状结肠癌根治术1例。结果手术均获成功,未发生手术并发症,手术时间60～360min,术中出血5～40mL,术后8～24h下床活动,12～72h排气、拔胃管进流食,2～5d拔除引流管,6～14d出院。随诊1～36个月,病人术前症状消失,复查内镜肿物未见复发。结论腹腔镜内镜联合手术治疗消化道疾病具有定位准确、创伤小、痛苦轻、疗效好等突出优点。

Treatment of digestive diseases by combined laparoscopy and endoscopy

[Objective] To investigate the clinical value of combined laparoscopy and endoscopy. [Methods] During the past 3 years, 18 patients were undergone laparoscopic and endoscopic operations. There were 13 cases of Heller-Dor for achalasia of cardia, 1 among them had been undergone cholecystectomy and resection of heman- gioma in left exterior lobe of liver in the meantime, 1 resection of hemangioma for hemangioma in lower esophagus, I resection of adenoma for Brunner adenoma and repair of hiatus hernia, toupet, cholecystectomy, appendectomy meanwhile, 1 wall resections and 1 sigmoid colectomy for 2 cases of polyp of sigmoid colon respectively, and 1 radical operation for rectal cancer. [Results] The operations were accomplished with no complications. The operative time was 120-360 minutes, the operative blood loss was 5-40 mL. Patients could leave bed 8-12 hours after operation, released gas and gastric tube was withdrawn and took liquid food 12-72 hours after operations. Abdominal drainage tube was taken out 2-5 days postoperation. The patients were discharged 7-14 days after operations. The preoperative symptomes disappeared and no recurrence for 1-27 months postoperation follow-up. [Conclusions] Combined laparoscopy and endoscopy has advantages of precise localization, minimal invasion, less pain and fine curative effect.