腹腔镜下结直肠癌手术(三)

3．2腹腔镜左半结肠切除术 3．2．1手术要点腹腔镜左半结肠切除术的要求往往高过腹腔镜右半结肠切除术，所以，除一套腹腔镜器械外，还应增备一套开腹手术器械，一旦腹腔镜手术中出现难以控制的出血以及必须开腹处理的特殊情况，应毫不犹豫中转开腹手术。     

腹腔镜下结直肠癌手术(一)

1我国腹腔镜结直肠癌手术现状与展望 1．1现状 提高结直肠癌患者的手术质量、术后生活质量及5年生存率，降低局部复发率，是结直肠外科医生始终不懈的追求目标。随着腹腔镜技术的广泛应用，腹腔镜下的结直肠外科手术在我国开始逐渐普及，这一创伤小、出血少、恢复快的微创术式也逐渐得到同道的认可和患者的欢迎。     

腹腔镜与开腹手术治疗结直肠癌疗效比较

目的探讨腹腔镜与开腹手术治疗结直肠癌的手术效果。方法把62例结直肠癌患者随机分为常规开腹手术组(常规组)和腹腔镜下结直肠癌手术组(观察组)各31例。观察两组患者术后肛门排气时间、住院天数和肠梗阻的发生率,并对疗效进行评价。结果观察组患者术后肛门排气时间和住院天数均显著少于常规组。常规组20例结肠癌术后有6例发生肠梗阻,发生率为30.0%,观察组22例结肠癌术后有1例发生肠梗阻,发生率为4.55%。常规组11例直肠癌术后有2例发生肠梗阻,发生率为18.18%,观察组9例直肠癌术后有1例发生肠梗阻,发生率为11.11%。结论腹腔镜下结直肠癌手术创伤小,术后恢复快,肠梗阻的发生率较少。     

腹腔镜下结直肠癌手术(四)

4腹腔镜TME直肠前切除术及低位、超低位前切除术 4．1TME的概念 4．1．1直肠系膜的解剖学基础直肠系膜是近年来逐渐受到重视的解剖结构，是具有重要临床意义的新概念。直肠存在着完整的系膜，由腹膜及盆筋膜脏层包绕直肠周围的脂肪、血管、淋巴和神经组织形成。盆腔腹膜返折以上的直肠前方及部分侧面有腹膜覆盖，以下的直肠则无腹膜覆盖，     

重视结直肠癌腹腔镜外科治疗的基本原则

近年来，随着腹腔镜技术的广泛应用，腹腔镜下的结直肠癌切除术在我国逐渐开始普及。这一创伤小，出血少，恢复快的微创术式也逐渐得到同道的认可和患者的欢迎。腹腔镜结直肠癌切除涉及到腹腔镜手术操作的特殊技能、肛肠外科的专业知识两方面，这两方面缺一不可，任何一方面的欠缺或不足都将直接影响到手术的质量、手术并发症发生率、肿瘤切除后的生存质量、局部复发率和5年生存率。     

腹腔镜下结直肠癌手术(五)

4.6 TME手术并发症及其防治 4.6.1 尿潴留、性功能障碍此并发症以超低位前切除术最为常见,手术操作过程中内脏植物神经损伤是主要原因,而内脏神经损伤可发生于手术操作的多个环节.     

腹腔镜下结直肠癌手术(六)

5腹腔镜TME经腹会阴直肠切除术 1908年Miles首创了经腹会阴直肠切除(abdominoperi-neal resection,.APR),近百年来该术式一直是低位直肠癌治疗的金标准.近20年来,随着分子生物学方法在结直肠癌研究中的应用,以及TME概念的提出并成功应用于临床,推动了直肠癌局部病理学研究的进程.     

结直肠癌腹腔镜手术与开腹手术的分析比较

结直肠癌是危害人类健康的主要恶性肿瘤之一,手术仍然是目前主要的治疗手段.腹腔镜结直肠癌手术已开展了十余年,不断发展,在结直肠外科领域逐渐巩固了地位.本文就结直肠癌的腹腔镜手术与开腹手术在安全性、对机体病理生理的影响、疗效等方面进行比较,探讨腹腔镜在结直肠癌治疗中的应用价值.     

腹腔镜结直肠癌切除术

1991年，Jakobs第一次报道腹腔镜结直肠切除术。目前，腹腔镜手术已广泛应用于治疗各种结直肠疾病，包括结直肠癌。越来越多的临床研究表明，腹腔镜结直肠癌切除术能获得与开腹手术相同的疗效，而且具有手术创伤小、术后恢复快、住院时间短、美容效果好等优点。     

Laparoscopic Surgery for Colorectal Polyps

Background:

Size, location, and type of colonic polyps may prevent colonoscopic polypectomy. Laparoscopic colectomy may serve as an optimal alternative in these patients. We assessed the perioperative outcome and the risk for cancer in patients operated on laparoscopically for colonic polyps not amenable to colonoscopic resection.

Methods:

An evaluation was conducted of our prospective accumulated data of a consecutive series of patients operated on for colonic polyps.

Results:

Sixty-four patients underwent laparoscopic re-section for colonic polyps during a 6-year period. This group comprised 18% of all our laparoscopic colorectal procedures. Forty-six percent were males, mean age was 71. Most of the polyps (66%) were located on the right side. No deaths occurred. Conversion was necessary in 3 patients (4.6%). Significant complications occurred in 3 patients (4.6%). Nine patients (14%) were found to have malignancy. Three of them had lymph-node involvement. No difference existed in polyp size between malignant and nonmalignant lesions.

Conclusions:

Laparoscopic colectomy for endoscopic nonresectable colonic polyps is a safe, simple procedure as reflected by the low rate of conversions and complications. However, invasive cancer may be found in the final pathology following surgery. This mandates a strict adherence to surgical oncological principles. Polyp size cannot predict the risk of malignancy.     

Tumor Localization for Laparoscopic Colorectal Surgery

Background Because palpating colonic tumors during laparoscopy is impossible, the precise location of a tumor must be identified before operation. The aim of this study was to evaluate the accuracy of various diagnostic methods that are used to localize colorectal tumors and to propose an adequate localization protocol for laparoscopic colorectal surgery. Methods A total of 310 patients underwent laparoscopy-assisted colectomy between April 2000 and March 2006. We investigated if the locations of the tumors that were estimated preoperatively were consistent with the actual locations according to the operation. Results All the tumors were correctly localized and resected. Altogether, 203 patients had complete endoscopic reports available. Colonoscopy was inaccurate for tumor localization in 23 cases (11.3%). In total, 104 patients (33.5%) underwent barium enema; five tumors (4.8%) were not visualized, and three tumors were incorrectly localized. Another group of 94 patients (30.3%) underwent computed tomography (CT) colonography, which identified 91 of 94 lesions (96.8%). Finally, 96 patients (31.0%) underwent endoscopic tattooing; 2 patients (2.1%) did not have tattoos visualized laparoscopically and required intraoperative colonoscopy to localize their lesions during resection. Dye spillage was found in six patients intraoperatively, but only one patient experienced clinical symptoms. Intraoperative colonoscopy was performed in four patients; two of the four were followed by endoscopic tattooing, and the other two underwent intraoperative colonoscopy for localization. All lesions were correctly localized by intraoperative colonoscopy. The accuracy of tumor localization was as follows: colonoscopy (180/203, 88.7%), barium enema (97/104, 93.3%), CT colonography (89/94, 94.7%), endoscopic tattooing (94/96, 97.9%), and intraoperative colonoscopy (4/4, 100%). Conclusions With a combination of methods, localization of tumors for laparoscopic surgery did not seem very different from that during open surgery. Preoperative endoscopic tattooing is a safe, highly effective method for localization. In the case of tattoo failure, intraoperative colonoscopy can be used for accurate localization.     

腹腔镜与开腹结直肠癌根治术近期疗效对比

目的分析对比腹腔镜与开腹结直肠癌根治术的近期疗效。方法回顾性分析我院2010年1月~2013年10月收治的120例结直肠癌患者的临床资料,其中腹腔镜手术组62例,开腹手术组58例。观察对比两组患者手术时间、出血量、肠蠕动时间、平均住院时间、术后恢复情况及并发症情况,并对肿瘤根治的有效性及安全性给予分析。结果两组患者均成功完成手术,无死亡病例。腹腔镜手术组手术时间长于开腹手术组(P0.05);术中出血量、术后引流量少于开腹手术组(P0.05);切口长度短于开腹手术组(P0.05);排气时间及住院时间短于开腹手术组(P0.05)。腹腔镜手术组术后并发症发生率为4.8%,明显低于开腹手术组的17.2%(P0.05)。结论腹腔镜根治性治疗结直肠癌是一种安全、微创、有效的手术方式,近期疗效满意,且具有创伤小、疼痛轻、恢复快、住院时间短等优点,值得临床广泛推广应用。