87例腹腔镜辅助低位直肠癌根治术中损伤性并发症的处理及术后护理

目的探讨腹腔镜辅助低位直肠癌根治术中损伤并发症的处理方法。方法87例患者中，全直肠系膜切除术（totalmesorectalexcision，TME）66例，经腹会阴联合直肠切除术（Miles术）21例。结果损伤并发症发生率大小依次为小肠损伤4．60％，骶前静脉丛损伤3．45％，阴道损伤3．45％，前列腺损伤2．30％，精囊、输精管损伤2．30％，输尿管损伤1．15％。除1例中转开腹手术外，其余14例均在腹腔镜下进行修补等处理，术后恢复好；出院后随访14个月，无远期并发症发生。结论严格掌握手术适应证，具备丰富的开腹手术经验与娴熟的器械操作专业技能，熟悉全直肠系膜切除术解剖及操作要领，发现问题及时处理、中转开腹均是降低腹腔镜手术并发症的关键。

Postoperative Care and Management of Wound Complications of Laparoscopic-Assisted Radical Resection for Lower Rectal Cancer in 87 Cases

Objective To explore the postoperative care and management of complications of laparoscopicassisted radical rectectomy in the treatment of lower rectal cancer. Methods The clinical data of 87 patients with rectal cancer performed laparoseopic radical rectectomy were analyzed retrospectively. 66 cases of them were performed by total mesorectal excision （TME）. The other 21 cases were performed by abdominal perineal resection（APR）. Results The incidence of intestinal lesion was 4. 60%, presacral venous plexus lesion was 3.45%, vagina lesion was 3.45%, prostate lesion was 2. 30%, seminal vesicle and deferent duct lesion was 2.30% and ureter lesion was 1.15%. Except for 1 case with conversion to open operation, all wound of organs were treated by laparoscopic techniques. The mean length of stay （LOS） was 11 d （9 - 14）. There were no long term postoperative complication happened during following - up 14 months. Conclusion Laparoscopic radical rectectomy is applicable to treat rectal cancer at proper indication. In order to decrease the wound complications, we need advanced laparoscopic skills and affluent experiences with operative recectomy, and being familiar with principles and anatomy of TME, and also changing operate methods when requiring.