达芬奇辅助结肠次全切除术治疗结肠克罗恩病(附1例报告)

目的:探讨达芬奇辅助结肠次全切除术治疗结肠克罗恩病的安全性与可行性.方法:2010年9月为1例结肠克罗恩病患者施行了达芬奇辅助结肠次全切除术,研究其手术技术、手术安全性及患者术后恢复情况.结果:手术顺利完成,无术中并发症发生.术后第2天恢复胃肠道功能,第3天恢复肠内营养,第6天转至康复病房.结论:达芬奇系统用于结肠次全...     

机器人手术系统辅助结肠癌手术13例

目的探讨达芬奇机器人手术系统辅助结肠癌手术的安全性与可行性。方法回顾性总结2010年5-11月实施的13例达芬奇机器人手术系统辅助结肠癌手术的治疗效果。结果13例结肠癌患者行右半结肠切除5例、左半结肠切除3例、乙状结肠切除5例。手术均顺利完成,无中转开腹。手术时间（171．5±31．8）min,术中失血量（54．6±21．8）ml,术后肠蠕动恢复时间为（60．9±15．8）h,术后住院时间（6．4±3．6）d。术后除1例切口脂肪液化外,未出现出血、吻合口瘘、吻合口狭窄等并发症。结论达芬奇机器人手术系统应用于结肠癌手术安全可行。     

达芬奇机器人系统辅助右半结肠切除术

目的 探讨达芬奇机器人系统辅助右半结肠切除术的安全性与可行性.方法 总结2010年5-11月完成的5例达芬奇辅助右半结肠切除术的方法 及术后恢复情况.结果 5例患者行右半结肠切除,其中1例同时行胆囊切除.手术均顺利完成,无中转开腹.手术时间140～200 min,术中失血量30～80 ml.术后无并发症发生.结论 达芬奇机器人系统应用于右半结肠癌手术是安全可行的.

Abstract：

Objective To investigate the safety and feasibility of robot-assisted laparoscopic right hemicolectomy for colonic cancer. Methods These 5 patients with ascending colonic cancer received robot-assisted laparoscopic right hemicolectomy. Results All operations were performed successfully. There was no postoperative complications. Da Vinci surgical system was found to be associated with fewer hemorrhage, rapid postoperative intestinal recovery, and therefore a shorter hospital stay. Conclusions Robot-assisted laparoscopic right hemicolectomy can be applied safely and with feasibility for colonic cancer.     

腹腔镜和开腹结肠切除手术治疗先天性巨结肠临床观察

目的 比较经腹腔镜结肠切除术及传统开腹结肠切除术治疗先天性巨结肠的疗效.方法 2009年4月至2010年12月我科收治先天性巨结肠患儿104例,分为两组,腹腔镜结肠切除术组70例,开腹结肠切除术组34例,比较两组患儿术前一般情况、术中情况、术后并发症及术后1年的排便情况.结果 左半结肠切除手术,腹腔镜组和开腹组治疗患儿的年龄和体重差异有统计学意义(P<0.05);无论是左半结肠切除还是次全结肠切除手术,腹腔镜组的术中出血均比开腹组明显减少(P<0.05);次全手术开腹组比腹腔镜组手术时间要短(P<0.05).两组术后并发症发生率差异无统计学意义,发生小肠结肠炎腹腔镜组12.8%,开腹组为17.7%.术后1年随访两组间情况差异无统计学意义.结论 腹腔镜手术治疗先天性巨结肠,不仅能获得传统开腹手术同样的效果,而且减小了手术对患儿的创伤,在伤口美观方面使患儿获益.     

腹腔镜下全结肠切除治疗多原发结肠癌3例

目的:探讨腹腔镜下全结肠切除术的可行性和安全性。方法:回顾分析腹腔镜全结肠切除术3例的临床资料。3例均为多原发结肠癌,在腹腔镜辅助下行全结肠切除术,并行肿瘤区域淋巴结清扫、回肠直肠吻合术。结果:3例手术顺利完成,无中转开腹,无手术死亡。平均手术时间300min(270～330min),平均出血量110ml(80～150ml),辅助切口平均长度6cm(5～7cm),平均术后住院8d(7～10d),无手术并发症。术后随访3例患者6～18个月,其中1例术后2个月出现肝内多发转移癌和脾转移癌,行B超介入射频治疗和静脉联合化疗后至今存活。结论:腹腔镜辅助全结肠切除术治疗多原发结肠癌安全可行,近期疗效良好。     

腹腔镜下左半结肠切除术56例临床分析

目的探讨腹腔镜下左半结肠切除术的安全性和可行性。方法对56例腹腔镜下左半结肠切除术患者的临床资料和随访情况进行回顾性分析。结果54例手术在腹腔镜下顺利完成,中转开腹2例、中转率3.57%（2/56）,无手术死亡。平均手术时间（168±42）min,平均出血量（75±45）ml,辅助切口平均长（6±1.5）cm,术后平均住院日（9±3）d。手术并发症发生率3.70%（2/54）,其中术后肠梗阻1例（发生率1.85%、1/54）、肺炎1例（发生率1.85%、1/54）。54例患者术后随访3～63个月,3例远处癌转移（复发率5.77%、3/52）,2例死亡,全组患者的腹壁穿刺孔及辅助小切口无肿瘤种植。结论腹腔镜下左半结肠切除术是安全可行的,手术近期疗效令人满意,长期结果有待进一步观察。     

Ⅰ期手术方案治疗左半结肠外科急症

目的:探讨左半结肠外科急症行不加结肠造瘘的Ⅰ期手术的可行性。方法:回顾总结32例不同病因的左半结肠外科急症行Ⅰ期手术手术方案的适应症及术中、术后处理方法经验。结果:32例均无发生吻合口瘘等严重并发症。结论:只要掌握适应症及术中、术后治疗方法,对左半结肠急症病人可行Ⅰ期手术方案。     

结肠次全切除术在急性梗阻性左半结肠癌治疗中的应用

目的:探讨结肠次全切除术在急性梗阻性左半结肠癌中的疗效.方法:回顾性分析13例可切除急性梗阻性左半结肠癌患者,均急诊行结肠次全切除术.结果:13例全部手术成功并痊愈出院.5例切口感染、脂肪液化,明显腹泻3例,均经综合治疗后好转.无吻合口瘘及腹腔感染发生.结论:严格掌握手术适应证,正确手术操作及积极的营养支持对症治疗,梗阻性左半结肠癌行结肠次全切除术是安全可靠的.     

左半结肠癌致急性肠梗阻Ⅰ期手术术式探讨

目的比较左半结肠癌致急性肠梗阻Ⅰ期根治性切除肠吻合手术时两种不同切除方法的疗效。方法58例左半结肠癌致急性肠梗阻患者行结肠次全切除术30例,左半结肠切除术28例。结果结肠次全切除和左半结肠切除患者手术时间分别为（150.0±21.4）min和（201.0±30.2）min,并发症发生率分别为16.7%和50.0%,住院病死率分别为0%和17.9%,两组比较均有统计学差异（P〈0.05）。结肠次全切除患者术后均有腹泻,左半结肠切除患者术后腹泻10例,分别于3个月和1月内大便基本成形。结肠次全切除和左半结肠切除5年生存率分别为37.0%和32.0%,两组比较无统计学差异（P〉0.05）。结论梗阻性左半结肠癌Ⅰ期根治性切除肠吻合手术方式中,结肠次全切除术明显优于左半结肠切除术,建议在合适的病例中推广应用。     

腹腔镜辅助下左半结肠切除5例报告

目的探讨腹腔镜辅助下左半结肠切除可行性。方法2004年8月-2006年8月，经临床筛选对5例降结肠癌施行腹腔镜辅助下左半结肠切除。手术步骤：①置入腹腔镜探查腹腔，判断病变性质及手术可行性；②游离左半结肠；③上腹正中5cm左右切口，腹腔外行肠系腹下动、静脉周围淋巴结清扫；④切除左半结肠，横结肠-乙状结肠吻合；⑤标本装入标本袋内取出标本，腹白线单层缝合。结果5例均在腹腔镜辅助下行左半结肠切除，无中转开腹，未出现不能控制的出血。手术时间100～220min，平均120min；术中出血量50～100ml，平均80ml。肿瘤全部完整切除，无破裂，完整取出标本的边界距肿瘤切缘10～15cm，术后病理证实切端未见癌细胞侵犯。术后住院6～10d，平均8d，术后无出血及吻合口漏。5例随访5、8、12、16、29个月，无复发，trocar穿刺孔及辅助小切口未见肿瘤种植转移，均无瘤生存。结论腹腔镜辅助下左半结肠切除安全，可行。     

Completely staple-free hand-sewn laparoscopic anastomosis in colorectal surgery

Colonic continuity following a laparoscopic left hemicolectomy is usually performed by using a circular stapler to achieve end-to-end colorectal anastomosis. However, not much consideration is given to the costs of this technique and the long-term risk of stenosis. In this paper, we report the first case of a completely staple-free hand-sewn laparoscopic colonic anastomosis (CSHLCA) following a laparoscopic left hemicolectomy for cancer. Total operative time was 170 minutes, and the time to perform the anastomosis was 38 minutes. The postoperative stay was uneventful, with a total hospital stay of 6 days. CSHLCA is feasible and can lower the cost of the laparoscopic procedure. It may be considered in countries with limited access to mechanical staplers.     

Laparoscopic right hemicolectomy with intracorporeal anastomosis. Technical aspects and personal experience

BACKGROUND: Laparoscopic colo-rectal surgery has gained wide acceptance as a treatment in a variety of benign and malignant diseases. The reproducibility and safety of all the principal colo-rectal procedures has been demonstrated, but some indications are still controversial. A great part of surgeons perform right hemicolectomy by laparo-assisted technique and consider it more difficult than left hemicolectomy. METHODS: A retrospective analysis of a series of 180 laparoscopic colon resections performed between 1994 and 2001 is presented. Surgical indications were: 46 cases of benign disorders and 134 colonic malignancy. The right hemicolectomy were 27 (15%): 2 benign and 25 malignant diseases. The technical aspects of completely laparoscopic right hemicolectomy is described in details. A completely mechanical intra-corporeal anastomosis is always performed. To remove the bowel specimen from the abdominal cavity it is put it in a large bag and pull it out of a 3-4 cm enlargement of a trocar-site (in the umbilical scar). RESULTS: Data of the 27 laparoscopic right hemicolectomy were analysed: there was 1 conversion to open surgery; no intra-operative complications were observed; the postoperative period was complicated by 1 anastomotic fistula. The median operative time was of 150 minutes. No case of port-site recurrence was observed. CONCLUSIONS: The laparoscopic colo-rectal surgery can reproduce in selected patients, the techniques performed in open surgery with minimally invasive treatment. It is possible to perform a completely laparoscopic right hemicolectomy after an adequate training in advanced laparoscopy, anyway there are many advantages: less postoperative pain, short-term postoperative ileus, earlier return to daily activity.     

Anorectal function problems after left hemicolectomy

BACKGROUND: The aim of this study was to evaluate the subjective anorectal function in patients with left hemicolectomy and to clarify the clinical factors influencing postoperative anorectal function problems. MATERIALS AND METHODS: One hundred and twenty one patients who underwent left hemicolectomy from April 2002 to December 2003 were enrolled in this study and sent questionnaires concerning anorectal function. Left hemicolectomy in patients with cancer was performed by high ligation of the inferior mesenteric artery; in patients with diverticulitis or polyposis, the inferior mesenteric artery was cut just below the branch of the left colonic artery. One hundred patients replied to the questionnaire: 52 men and 48 women, aged 37 to 85, with a mean age of 66.6 years. Differences were analyzed for statistical significance by the Chi square test and by logistic regression. RESULTS: Anorectal function problems was present in 33% of patients: female gender (P = 0.02), laparoscopic surgery (P = 0.04), and postoperative diarrhea (P = 0.04) had significant independent effects on anorectal function problems. Transient early fecal incontinence was observed in 16% of patients and laparoscopic surgery had significant independent effects on this problem (P = 0.04). Inability to discriminate between gas and stool, tenesmus, or urgency were present in 21%, 18%, and 17% of cases, respectively, and were independently associated respectively with laparoscopic surgery (P = 0.005) and postoperative diarrhea (P = 0.019) (P = 0.015). CONCLUSION: In our study the following two issues were clarified: anorectal function problems are frequent after left hemicolectomy, and the laparoscopic technique is linked to poor postoperative anorectal function. The technical methods of high ligation of the inferior mesenteric artery could explain this result.     

腹腔镜右半结肠癌根治术中间入路与混合入路的近期疗效对比

目的:探讨腹腔镜中间入路与混合入路治疗右半结肠癌的近期疗效.方法:回顾分析2016年1月至2021年8月为109例患者行腹腔镜右半结肠癌根治术的临床资料,比较两组近期疗效.结果:混合入路组手术时间、术中出血量、术后首次排便时间均少于中间入路组,差异有统计学意义(P<0.05);两组术中淋巴结清扫数量、并发症发生率及其他...     

中青年和老年结肠癌患者行腹腔镜下根治术的疗效差异比较

目的探索中青年和老年结肠癌患者行腹腔镜下根治术的疗效。 方法选取2012年1月至2014年2月中青年和老年结肠癌确诊患者各60例,分为中青年组和老年组,进行腹腔镜下根治术,其中中青年组患者中28例进行左半结肠切除术,32例进行右半结肠切除术;老年组患者中24例行左半结肠切除术,36例行右半结肠切除术,采用SPSS 18.0版统计学软件进行分析,术中术后相关指标以均数±标准差表示,组间比较采用t检验;术后并发症发生率采用χ²检验;以P<0.05表示差异具有统计学意义。 结果中青年组和老年组患者进行左半切结肠切除术的并发症发生率分别为7.1%(2/28)、8.3%(2/24), P>0.05;两组患者随访2年的复发率、近端转移率差异无统计学意义;右半切除术的并发症发生率分别为15.6%(5/32)、33.3%(12/36),差异有显著统计学意义(P<0.05),结果表明中青年组右半结肠切除术患者术后并发症发生率明显低于老年组。 结论不同年龄段结肠癌患者进行右半结肠切除术的术后并发症发生率均明显高于左半结肠切除术,但中青年患者术后并发症发生率明显低于老年患者。     

结肠癌腹腔镜下切除与开腹切除的短期疗效对比

目的比较结肠癌腹腔镜辅助下切除与开腹切除的短期疗效。方法对2004年1月～2009年12月笔者所在医院行腹腔镜辅助下结肠癌根治术30例及开腹结肠癌根治术45例患者的临床资料进行回顾性分析,比较两组患者手术及术后情况。结果腹腔镜组与开腹组手术时间分别为（150.45±22.10）min和（148.56±28.55）min;切口总长度分别为（6.55±0.54）cm和（18.56±2.35）cm;出血量分别为（33.52±23.08）mL和（40.35±25.12）mL;淋巴结清除数分别为（12.53±2.36）枚和（13.24±2.05）枚;术后镇痛时间分别为（49.00±2.30）min和（89.00±9.30）min;术后下床活动时间分别为（30.85±7.09）min和（72.25±9.73）min;术后平均住院天数（6.05±1.09）d和（10.06±2.16）d;术后肛门排气时间分别为（25.08±6.89）min和（66.28±13.57）min;两组患者病理切缘均为阴性,均无术后并发症及术后死亡病例。结论腹腔镜辅助下结肠癌根治术安全可行,具有患者创伤小、术后康复快的优点,根治效果可达到开腹手术的水平。     

县级医院复制基于膜解剖的腹腔镜右半结肠癌根治术的初步经验 (附28例报告)

目的:探讨县级医院复制基于膜解剖右半结肠癌根治性切除术的可行性及应用价值.方法:回顾分析28例腹腔镜右半结肠癌手术(基于膜解剖术式)患者的临床资料,记录手术时间、术中出血量、清扫淋巴结数量、术后并发症、术后恢复情况.结果:28例手术均获成功,手术时间135～246 min,平均(182.2±41.3)min;术中出血量...     

3D腹腔镜治疗胃肠肿瘤44例临床分析

目的探讨3D腹腔镜在胃肠肿瘤手术中的应用。 方法回顾性分析2013年10月至2015年6月应用Olympus 3D腹腔镜系统完成手术44例的临床资料,其中右半结肠切除术12例,左半结肠切除3例,乙状结肠切除11例,低位直肠前切除术10例,远端胃癌根治术8例,统计分析手术时间、出血量、术后住院时间等数据。 结果44例胃肠肿瘤腹腔镜手术均获成功,无中转开腹。手术时间为(173.52±48.65) min,术中出血量为(71.59±35.17) ml,术后住院时间为(8.66±2.21) d。 结论3D腹腔镜成像系统还原了三维立体手术视野,手术解剖更精细,从而减少手术并发症发生,降低手术难度,缩短手术时间,具有腹腔镜和开腹的优势,适合更复杂的腹腔镜手术。