腹腔镜微创技术施行直肠癌腹会阴联合切除手术的体会

目的:总结腹腔镜微创技术施行腹会阴联合切除术(abdom inal pelvic resection,APR)治疗低位直肠癌的手术体会。方法:2003年1月至2006年12月,我院为17例低位直肠癌患者行腹腔镜微创APR根治术。其中男10例,女7例,45~82岁,平均72岁。腹部手术在腹腔镜下完成,会阴部手术按常规手术进行。结果:17例中14例(82.4%)采用完全腹腔镜术式,3例(17.6%)采用腹腔镜辅助术式。手术中均未行盆底腹膜关闭和结肠造口旁间隙关闭。平均手术时间为(166.2±42.7)m in,全组无手术死亡病例。术后早期并发症有会阴部切口感染2例(11.8%),不全性肠梗阻1例(5.9%)。术后随访2~48个月,平均26个月,最长无瘤生存期48个月,造口旁疝1例(5.9%),远处转移1例(5.9%),无局部复发,无戳口和切口肿瘤种植以及肠梗阻发生。结论:腹腔镜微创技术用于APR手术具有患者创伤小的优势;术中造成的系膜裂孔和盆底腹膜均无缝合关闭的必要,但结肠造口必须严密缝合腹膜防止造口旁疝形成;会阴部手术必须严格无菌操作预防感染。腹腔镜微创技术是APR手术的较好方式。

The experiences of laparoscopic minimal invasive operation for abdominal pelvic resection in lower rectal carcinoma

Objective:To summarize the experiences of laparoscopic minimal invasive operation of abdominal pelvic resection(APR)in lower rectal carcinoma.Methods:Seventeen cases(10 males and 7 females) underwent the laparoscopic minimal invasive APR operation from Jan.2003 to Dec.2006.The median age was 72 years(45-82 years).The abdominal operations were completed viaparoscopic approach and the pelvic operations were done according to the routine procedure.Results:Fourteen cases(82.4%) underwent total laparoscopic.Three cases(17.6%) underwent assistant laparoscopic surgery.The mesocolon and pelvic peritoneum were not sutured in any case.The average time of the operation was(166.2±47.7)min.There was no dead case after operation.The earlier complications after operation were pelvic incisional infection(11.8%)and partial bowel obstruction(5.9%).With a follow-up of 2 to 48 months,the longest time of free tumor survival was 48 months,para-ostomy hernia occured 1 case(5.9%),and metastasis occured 1 case(5.9%),but there was no tumor planted in portsite and incision,and no bowel obstruction occured.Conclusions:The laparoscopic surgery in APR have advantage of minimal invasion.It is not necessary to suture the mesocolon and pelvic peritoneum.The ostomy must be done well in order to prevent the para-ostomy hernia.It is important to prevent the infection of pelvic incision.The laparoscopic minimal invasive operation of APR is a satisfactory procedure for lower rectal carcinoma.