腹腔镜结直肠癌根治术治疗结直肠癌患者的疗效观察及对胃肠功能的影响研究

目的探讨腹腔镜结直肠癌根治术治疗结直肠癌患者的临床疗效以及对胃肠功能的影响。方法选取62例结直肠癌患者为研究对象,采取数字表法随机分为腹腔镜直肠癌根治术组及开腹结直肠癌根治术组各31例。结果腹腔镜组手术时间与开腹手术时间比较差异无显著性;出血量(84.77±12.06)mL、住院时间(10.20±1.40)d、并发症发生率(22.58%)、肠鸣音恢复时间(2.76±0.05)d、排气时间(2.51±1.03)d、进食时间(53.20±20.04)h等均明显低于开腹组(P<0.05)。结论腹腔镜结直肠癌根治术治疗结直肠癌,术中出血量少、手术时间短、住院时间短、并发症低,且对胃肠功能造成的影响小。     

腹腔镜下经肛拖出直肠癌根治术超低位保肛的临床研究

目的探讨腹腔镜下经肛拖出直肠癌根治术超低位保肛的可行性、安全性、根治性及短期临床疗效。方法回顾我院收治的127例超低位直肠癌,运用腹腔镜经肛拖出直肠癌根治术行超低位保肛65例（腹腔镜组）、直肠癌超低位前切除术62例（开腹组）,比较两组术中、术后及愈后各项指标。结果腹腔镜组术中出血量及术后肠道功能恢复时间、止痛药物使用时间、住院时间均优于开腹组（P〈0.05）。两组手术时间、清扫淋巴结数量、术后吻合口漏、吻合口狭窄、复发、转移、大便失禁和总生存率各项差异无统计学意义（P〉0.05）。结论腹腔镜下经肛拖出直肠癌根治术超低位保肛符合肿瘤学根治性原则,安全可行,术后恢复快,适合用于超低位直肠癌保肛。     

达芬奇机器人与腹腔镜直肠癌根治术的近期疗效对比

目的:比较达芬奇机器人与腹腔镜直肠癌根治术的近期疗效.方法:回顾分析2014-12/2016-01在南昌大学第一附属医院行直肠癌根治术120例患者的临床资料,其中运用达芬奇机器人手术系统行直肠癌根治术63例(机器人组),57例行腹腔镜直肠癌根治术(腹腔镜组).比较两组患者手术情况、术后恢复情况及术后并发症.结果:机器人组手术时间明显长于腹腔镜组(161.1 min±41.4 min vs 135.5 min±39.1m i n,P=0.001),术中出血量少于腹腔镜组(104.8 m L±70.8 m L vs 140.3 m L±81.4 m L,P=0.013),低位直肠癌的保肛率高于腹腔镜组[65.0%(13/20)vs 25.0%(4/16),P=0.017],排气时间、进流质时间、拔尿管时间均短于腹腔镜组(P0.05),但住院费用明显高于腹腔镜组(2.7万元±1.1万元vs 4.3万元±1.3万元,P=0.000).两组手术均无中转开腹.两组在标本切除长度、肿瘤下缘距下切缘的长度、淋巴结清扫数目、术后住院时间和术后并发症发生率方面比较差异无统计意义(P0.05).结论:达芬奇机器人直肠癌根治术取得与腹腔镜手术相同的根治效果,并具有创伤小、术中出血少、术后恢复快、保肛率高等优势,可作为治疗直肠癌的有效手段之一.     

腹腔镜结直肠癌根治术的可行性及安全性临床研究

目的 探讨腹腔镜结直肠癌手术的可行性、安全性以及肿瘤的根治性.方法 回顾性分析48例腹腔镜结直肠癌手术病例和同期有可比性的131例传统开腹结直肠癌手术病例的临床资料.结果 腹腔镜组较传统开腹手术组的切口长度[ (5.54 ±1.65)cm比(14.42 ±2.49) cm]、肛门首次排气时间[(2.21±1.42)d比(3.94±1.50)d]、人均肠道干预次数[(0.3±0.7)比(1.7±2.1)]、首次进食时间[(3.08±1.64)d比(4.47±1.69)d]、人均镇痛次数[(0.50±1.0)比(0.90±1.2)]、尿管留置时间[(3.46±1.97)d比(5.06±2.81)d]等指标明显减少,差异均具有统计学意义(P均＜0.05);并发症发生率、术后住院时间、住院总时间,腹腔镜组均小于开腹组,但差异无统计学意义(P＞0.05).腹腔镜组平均手术时间明显长于传统手术组[( 217.38±68.35) min比(131.40±54.33)min],具有统计学意义(P＜0.05).术中出血量,术中及术后输血量,手术切除肿块最大直径,结肠标本肿块距近切缘、远切缘的长度,直肠标本肿块距近切缘、远切缘长度,清扫淋巴结数目及阳性数目,两组比较差异均无统计学意义(P均＞0.05).结论 腹腔镜结直肠癌手术是一项安全、可行的技术,且可以达到与传统开腹结直肠癌手术同样的短期根治效果.     

胃困难部位间质瘤内镜与腹腔镜治疗临床疗效比较

目的 比较内镜手术[内镜下黏膜剥离术(endoscopic submucosal dissection, ESD)或内镜下全层切除术(endoscopic full thickness resection, EFTR)]和腹腔镜手术治疗胃困难部位间质瘤的安全性和有效性。方法 回顾性分析我院2017年1月至2021年12月行内镜下治疗和腹腔镜治疗的位于胃困难部位且术后病理证实为胃肠道间质瘤患者的临床资料，比较两组患者的基线资料、手术安全性、短期预后及随访结果。结果 共纳入64例患者，30例行内镜下治疗，34例行腹腔镜治疗。腹腔镜组肿瘤直径(3.51±0.80)cm大于内镜组(2.88±0.80)cm,差异有统计学意义(P<0.01),两组患者性别、年龄、首发症状、个人史、肿瘤部位、肿瘤危险度、核分裂象、术后辅助治疗情况比较，差异均无统计学意义(P>0.05)。内镜组患者术后进食时间早于腹腔镜组[(3.1±0.5)d vs(5.4±2.0)d,P<0.01],术后住院时间短于腹腔镜组[(6.8±1.3)d vs(9.6±4.1)d,P=0.001],两组患者手术整块切除率...     

腹腔镜下远端胃癌根治术与传统开腹手术治疗早期胃癌的疗效比较

目的比较腹腔镜下远端胃癌根治术与传统开腹手术治疗早期胃癌的临床效果。方法选取该院2013-11~2014-11收治的72例早期胃癌患者,按随机数字表法分为对照组(36例)和观察组(36例)。对照组行传统开腹手术治疗;观察组于腹腔镜下行远端胃癌根治术治疗。统计两组患者手术时间、切口长度、术中出血量、淋巴结清扫数量、术后肛门排气时间、下床活动时间、恢复半流质时间及住院天数,观察两组患者术后并发症发生情况,随访12个月,了解患者术后复发、癌细胞转移及存活情况。结果观察组手术时间、切口长度、术中出血量[(168.8±30.9)min、(6.6±2.3)cm、(131.8±63.4)ml]和术后肛门排气时间、下床活动时间、恢复半流质时间及住院天数[(2.9±1.4)、(2.4±0.9)、(7.4±1.6)及(10.7±3.6)d]均短于或少于对照组(P0.05);观察组患者术后并发症发生率(8.3%)较对照组(27.6%)低,两组比较差异有统计学意义(P0.05)。随访12个月,两组患者均无肿瘤局部复发、癌细胞转移及死亡病例,存活率为100.0%。结论腹腔镜下远端胃癌根治术治疗早期胃癌可获得与开腹手术相同的效果,但其手术时间短,术中出血量少,有利于患者术后尽早恢复,优势更显著。     

腹腔镜手术与经腹直肠癌根治术治疗大肠癌临床疗效的比较

目的比较腹腔镜手术与经腹直肠癌根治术治疗大肠癌(CRC)的临床疗效。方法选择该院2009年1月至2010年1月收治的80例CRC患者,按随机数字表法平均分为两组,研究组患者使用腹腔镜手术治疗,对照组患者使用经腹直肠癌根治术治疗。比较两组患者手术时间、术中出血量、术后排气时间、住院时间、并发症发生率、术后转移复发率及5a无瘤生存率,同时比较两组患者手术前后生存质量变化情况。结果研究组患者手术时间、术中出血量、术后排气时间及住院时间均明显低于对照组(P0.05);术后1个月消化病生存质量指数(GLQI)总分较术前明显升高,且高于对照组(P0.05);术后并发症发生率明显低于对照组(P0.05);术后转移复发率及5a无瘤生存率与对照组比较差异无统计学意义(P0.05)。结论使用腹腔镜手术治疗CRC疗效显著优于传统经腹直肠癌根治术,且安全性高,可明显改善患者术后生存质量,值得临床推广。     

内镜辅助腹腔镜治疗胃肠道间质瘤20例

目的:探讨内镜辅助腹腔镜(双镜联合)下切除胃肠道间质瘤(gastrointestinal stromal tumors,GISTs)的安全性、可行性.方法:回顾性分析南京医科大学第二附属医院消化医学中心2008-2012采用双镜联合、单纯腹腔镜及传统开腹手术治疗GISTs共95例,比较3组治疗手术时间、术中出血量、术后胃肠道功能恢复时间、术后下床活动时间及术后住院日.结果:所有手术均顺利完成,无死亡及并发症.随访至今无复发.其中双镜联合组、腹腔镜组及开腹组手术时间分别为63.0min±7.8min、81.6min±6.0min、134.9min±12.9min,术中出血量为24.5mL±4.6mL、27.1mL±7.1mL、112.4mL±22.5mL,术后胃肠道功能恢复时间33.4h±2.7h、34.6h±5.2h、36.9h±3.2h,术后下床活动时间37.1h±4.8h、38.0h±3.7h、48.6h±4.0h,术后住院日7.8d±1.4d、8.1d±1.2d、9.4d±1.8d.其中双镜联合组手术时间显著低于腹腔镜(P=0.000),双镜联合组手术时间、术中出血量、术后胃肠道功能恢复时间、术后下床时间术后住院日显著低于开腹组(均P<0.05).结论:内镜辅助腹腔镜下的双镜联合手术治疗GISTs是安全可行的,具有定位准确、创伤小,术后恢复快等优点,符合微创治疗思路.近期疗效令人满意,远期结果有待进一步观察.     

加速康复外科理念在老年患者腹腔镜辅助胃癌根治术中的应用

目的探讨实施腹腔镜辅助胃癌根治术老年患者应用加速康复外科理念(ERAS)的效果及安全性。方法入选铜陵市人民医院胃肠外科2015年12月至2018年12月拟行腹腔镜辅助胃癌根治术患者80例,随机数表法分为ERAS组和常规组,每组40例,比较2组患者术后相关指标和并发症。应用SPSS 22.0统计软件对数据进行分析。依据数据类型,采用t检验或χ2检验进行组间比较。结果相比常规组,ERAS组术后首次通气时间[(53.77±23.53)和(64.24±22.44)h]、首次排便时间[(60.92±22.15)和(75.10±22.25)h]、首次下床活动时间[(18.77±3.27)和(26.67±4.29)h]、首次经口流质饮食时间[(22.26±9.64)和(89.47±13.39)h]、肠外营养时间[(5.43±1.57)和(7.46±1.45)d]、腹腔引流管拔除时间[(4.90±1.24)和(6.60±1.04)d]和住院时间[(8.73±1.80)和(10.83±2.07)d]短,术后住院费用[(5.35±0.58)万元和(6.06±0.65)万元]低,差异均有统计学意义(P<0.05)。ERAS组相比常规组咽喉疼痛[7.5%(3/40)和27.5%(11/40)]、切口疼痛>Ⅱ级[5.0%(2/40)和20.0%(8/40)]、术后并发症Clavien-DindoⅠ级[17.5%(7/40)和37.5%(15/40)]发生率低,差异均具有统计学意义(P<0.05)。结论ERAS在老年患者腹腔镜胃癌根治术中应用安全有效,可降低术后并发症Clavien-DindoⅠ级发生率。     

ⅡⅢ期直肠癌根治术后放疗同步希罗达化疗的疗效

目的:回顾性分析Ⅱ、Ⅲ期直肠癌患者术后放疗同步联合希罗达化疗的疗效.方法:2000-01/2004-12收治直肠癌根治患者103例.按治疗方法分为3组.(1)单纯手术组(n=23),行Mile's或Dixon式根治术;(2)术后同步放化疗组(n=32),患者先行Mile's或Dixoil式根治术,术后2 wk开始放疗,每4.6-5 wk DT46-50 Gy/23-25次;放疗第1天起同时行化疗,希罗达1600 mg(m2·d),每天2次,第1-14天,每3 wk重复1个疗程,共4-6个疗程;(3)术后序贯放化疗组(n=48),手术及放疗方法同上,化疗结束后给予放疗.奥沙利铂130 mg(m2·d),每天1次,第1-14天;希罗达1000 mg(m2·d),每天2次,第1-14天,每3 wk重复1个疗程,共4-6个疗程.结果:术后同步放化疗组5年生存率为62.5%,高于单纯手术组的52.2%(P=0.024),但与序贯放化疗组(54.2%)相似(P=0.077);同步放化疗组局部复发率为6.25%,明显低于序贯放化疗组的31.25%(P=0.007)及单纯手术组(39.13,P=0.008);序贯放化疗组的局部复发率低于单纯手术组,但无明显差异(P=0.511).同步放化疗组的3/4度不良反应与序贯放化疗组相比无差异.结论:放疗联合希罗达同步治疗Ⅱ、Ⅲ期直肠癌术后患者可显著降低肿瘤局部复发率,5年生存率高于单纯手术,不良反应与序贯放化疗相比并未增加.     

直肠腺瘤性息肉局部切除治疗的对比研究

目的探讨内镜微创治疗术、经肛门内镜下显微手术、经肛门局部切除术针对直肠腺瘤性息肉的治疗价值。方法回顾性收集2009年至2011年行内镜微创治疗术（包括内镜黏膜切除术、内镜黏膜下剥离术及内镜下常规息肉切除,内镜微创治疗组）,经肛门内镜下显微手术（经肛门内镜下显微手术组）及经肛门局部切除术（经肛门局部切除组）的直肠腺瘤性息肉患者195例,每组65例,汇总入选患者的临床资料并行统计分析。研究指标包括患者性别和年龄、术前疾病状况（病变形态分型、距肛缘距离、直径以及病理组织学分型）、手术疗效（成功率、术中及术后并发症发生率）、手术时间、住院时间及治疗费用。结果内镜微创治疗组病变距肛缘（8．46±3．27）em,明显长于经肛门局部切除组的（6．83±2．99）em（P〈0．05）。手术成功率（P=0．774）、术后出血发生率（P=0．632）3组间差异均无统计学意义。内镜微创治疗组术中出血量较多（≥100m1）者为6．2％（4／65）,明显少于经肛门局部切除组的21．5％（14／65）（P〈0．05）。内镜微创治疗组平均手术时间、平均住院时间和平均治疗费用均明显短于或少于其他2组（P〈0．01）。结论内镜微创治疗术是直肠腺瘤性息肉局部切除治疗的理想手术方式。     

腹腔镜早期胃癌根治术的临床研究

目的:探讨腹腔镜胃癌根治术在早期胃癌治疗中的临床应用。方法:回顾性分析2004年10月至2009年12月间79例接受腹腔镜胃癌根治术的早期胃癌患者的临床资料,包括手术方式、手术时间、术中失血、术后排气时间、术后住院天数、并发症、术后病理和随访等。结果:除1例中转开腹手术外,其余78例均在腹腔镜下完成胃切除和淋巴结清扫,其中腹腔镜远端胃切除术74例,近端胃切除术2例,全胃切除术2例;腹腔镜下D1+α式淋巴结清扫34例,D1+β式淋巴结清扫15例,D2式淋巴结清扫29例。手术时间为(202.9±45.6)min,术中失血(144.5±146.5)mL,术后排气时间(2.8±1.0)d,术后住院天数为(11.3±5.6)d,8例(10.1%)患者出现腹腔内出血、吻合口漏、小肠梗阻等,经手术和非手术治疗后痊愈。手术上、下切缘距离肿瘤为(4.0±1.9)cm和(3.6±1.7)cm,手术平均清扫淋巴结(13.1±6.5)枚,其中有3例(3.8%)发现淋巴结转移。术后随访2～64个月,均无肿瘤复发和远处转移。结论:腹腔镜胃癌根治术是治疗早期胃癌安全、可行、微创、有效的手术方法。     

Stapled Transanal Rectal Resection Under Laparoscopic Surveillance for Rectocele and Concomitant Enterocele

Purpose Stapled transanal rectal resection recently became a recommended surgical procedure for obstructed defecation syndrome. One problem when using a transanal stapling device for rectal surgery is the potential threat to structures located in front of the anterior rectal wall. We decided to perform a combined procedure of transanal rectal resection with a simultaneous laparoscopy for patients with obstructed defecation syndrome and an enterocele. Methods Between November 2002 and May 2005 a total of 41 patients were treated surgically for obstructed defecation syndrome. Four patients with concomitant enterocele underwent stapled transanal rectal resection under laparoscopic surveillance. Before surgery all patients underwent preoperative assessment, including clinical examination, colonoscopy, conventional video defecography, dynamic magnetic resonance imaging defecography, gynecology examinations, and psychologic evaluation. Results The mean operative time was 50 (±16.5) minutes for the conventional stapled transanal rectal resection and 67 (±14.1) minutes for combined laparoscopy and stapled transanal rectal resection (P < 0.01). Three major complications were observed: two had bleeding in the staple line (one from each group) and one had a late abscess in the staple line. Conclusions The combination of the stapled transanal rectal resection procedure and laparoscopy provides the opportunity to perform transanal rectal resection without the threat of intra-abdominal lesions caused by enterocele. Reprints are not available.     

Experience of Endoscopic Transanal Resections With a Urologic Resectoscope in 131 Patients

Purpose Endoscopic transanal resection of rectal adenomas and other presumably benign lesions is not widespread. The purpose of this study was to evaluate the efficacy and the safety of endoscopic transanal resection. Methods Patients who underwent endoscopic transanal resection at three Stockholm hospitals between 1993 and 2004 were studied retrospectively with respect to patient and lesion characteristics, complications, follow-up time, and recurrence rates. Results One hundred eighty endoscopic transanal resection procedures were performed in 131 patients. The tissue diagnosis was adenoma in 160 operative cases, cancer in 12 operative cases, and hyperplasia, fibrosis, or normal mucosa in the remaining 8 operative cases. Among the patients with rectal adenomas, one endoscopic transanal resection was sufficient in 77 cases and in 16 cases the surgery was performed in more than one session because of the large size of the adenoma. In 27 cases there were recurrences that needed additional endoscopic transanal resection or other surgery. The median time until recurrence was seven months, but there were no recurrent rectal carcinomas. In 16 operative cases there were complications. Two patients had to undergo a Hartman's procedure as a result of a bowel perforation, and one patient had to be reoperated on because of bleeding. There were no perioperative deaths. The median follow-up time without recurrence was 32 (range, 0–67) months. Conclusions Endoscopic transanal resection is a feasible and oncologically safe option for treatment of rectal adenomas, especially in cases where conventional transanal resection or transanal endoscopic microsurgery are unavailable or unsuitable because of the characteristics and localization of the lesion. Presented at the Swedish Surgical Week, G?vle, Sweden, August 22 to 26 2005. Reprints are not available.     

TEM治疗直肠肿瘤19例体会

目的总结经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)治疗直肠肿瘤的手术经验及技巧。 方法2011年5月～2013年12月,对19例直肠肿瘤行TEM治疗,选择适当体位使直肠肿瘤位于TEM器械视野下半区,距肿瘤边缘至少0.5～1 cm行肠壁全层或粘膜下切除,创面连续缝合关闭。 结果19例直肠病变均获得完整切除,2例合并横结肠癌同时行横结肠癌根治术,平均手术时间(55.8±37.7)分钟,术后平均住院时间(8.5±3.3)天。术后2例患者出现肛门出血,1例绒毛状管状腺瘤复发,其余病例均无复发。 结论TEM手术体位选择非常重要,病变切除及创面缝合过程应遵循一定的手术方法,不同病变选择不同的切除方式;TEM存在学习曲线,初学者应选择手术相对简单的病例进行经验积累。     

Transanal minimally invasive surgery (TAMIS) using a new disposable device: our initial experience

Disposable single-port surgery devices have been used for transanal minimally invasive surgery (TAMIS). Their advantage, compared to transanal endoscopic microsurgery, is that they do not require special equipment or training. The aim of this study was to assess our initial experience using the single-site laparoscopic (SSL?) access system (Ethicon Endo-Surgery, Cincinnati, OH, USA) for TAMIS. Five patients eligible for local excision of rectal tumors, four males and one female, mean age 58 years (range 50–78), underwent surgery using the SSL? device. The average distance from anal verge was 4 cm (range 1–6). Four patients had an initial diagnosis of adenoma, and one had a previous endoscopic excision of a T1 adenocarcinoma with positive margins. In one patient, due to the lack of exposure, the procedure was converted to a low anterior resection. In the remaining four patients, average setup time was 7 minutes (range 4–15) and average operative time was 52 minutes (range 38–72). All resection margins were tumor free. There were no postoperative complications. Two of the presumed adenomas were intramucosal adenocarcinomas, while one patient had a T2 tumor and underwent radical surgery. Although at the present time the appropriate use of local excision is still under debate, TAMIS is a technique with great potential. Because of its simplicity and similarity with conventional laparoscopic surgery, it can be learned easily by surgeons not trained in transanal endoscopic microsurgery.     

Transanal endoscopic microsurgery

PURPOSE: The aim of this study was to describe a single institution's experience with transanal endoscopic microsurgery in patients with benign and malignant rectal tumors. PATIENTS: Between January 1992 and April 1998, 75 patients with a mean follow up of 38 months, underwent transanal endoscopic microsurgery excision of benign (46) or malignant (29) rectal tumors, located 3 to 18 cm from the dentate line. RESULTS: A total of 3 of 46 (6.5 percent) patients with benign tumors underwent conversion to radical surgery owing to tumor size. During the follow-up period, benign tumor recurrence was observed in four (9 percent) patients, three of whom were managed by repeat transanal endoscopic microsurgery, whereas one required radical surgery. Histologic staging of malignant tumors was T1 (10), T2 (10), and T3 (9). Seven patients with either inadequate resection margins or T3 tumors were complimented with radical surgery. Of the remaining 22 patients, 11 received adjuvant radiation therapy whereas 11 had no further treatment. Four (18 percent) had recurrent disease, which was managed by repeat transanal endoscopic microsurgery in two, radical surgery in one, and laser ablation in one. No cancer-related deaths were observed during the follow-up period. There was one operative mortality in a cardiac-crippled patient. Postoperative complications were mainly of a minor character and included fever, urinary retention, and bleeding; none of which required reintervention. Rectourethral fistula developed in one patient who underwent repeat transanal endoscopic microsurgery excision for a T3 malignancy. Fecal soiling was transient in three patients and persisted in two. CONCLUSION: Transanal endoscopic microsurgery excision is a safe and precise technique that is well tolerated even in high operative risk patients. Transanal endoscopic microsurgery may become a procedure of choice for benign rectal tumors and selected early malignant neoplasms.     

A comparison of transanal excision and endoscopic resection for early rectal cancer

AIM: To compare the outcomes of endoscopic resection with transanal excision in patients with early rectal cancer.METHODS: Thirty-two patients with early rectal cancer were treated by transanal excision or endoscopic resection between May 1999 and December 2007. The patients were regularly re-examined by means of colonoscopy and abdominal computed tomography after resection of the early rectal cancer. Complications, length of hospital-stay, disease recurrence and follow up outcomes were assessed.RESULTS: Sixteen patients were treated by endoscopic resection and 16 patients were treated by transanal excision. No significant differences were present in the baseline characteristics. The rate of complete resection in the endoscopic resection group was 93.8%, compared to 87.5% in the transanal excision group (P = 0.544). The mean length of hospital-stay in the endoscopic resection group was 2.7 ± 1.1 d, compared to 8.9 ± 2.7 d in the transanal excision group (P = 0.001). The median follow up was 15.0 mo (range 6-99). During the follow up period, there was no case of recurrent disease in either group.CONCLUSION: Endoscopic resection was a safe and effective method for the treatment of early rectal cancers and its outcomes were comparable to those of transanal excision procedures.     

腹腔镜肝切除联合微波消融治疗肝细胞癌患者疗效及安全性评价

目的 探讨微波消融联合腹腔镜肝切除治疗肝细胞癌合并肝硬化患者的临床疗效及安全性。方法 收集2009年3月至2015年3月于我院进行治疗的肝细胞癌合并肝硬化患者70例,对观察组38例患者行微波消融联合腹腔镜肝切除治疗,对照组32例患者接受腹腔镜肝切除治疗。对两组患者围手术期情况、手术前后肝功能指标、完全切除率、术后复发率和并发症等进行观察和比较。结果 观察组患者手术时间为（162.3±32.4） min,明显长于对照组【（131.0±27.9） min,P<0.05】,观察组术中出血量、腹腔引流管拔管时间和术后住院时间分别为【（132.5±25.6） mL、（5.2±1.3） d和7.3±1.8） d】,均明显少于或短于对照组【（368.4±67.1） mL、（7.0±1.6） d和（10.4±2.0） d,P<0.05】;观察组术后7 d总胆红素和谷丙转氨酶分别为【（19.7±5.2）μmol/L和（86.7±31.4） IU/L】,显著低于对照组【（24.1±5.8） μmol/L和（132.6±27.5） IU/L,P<0.05】,观察组术后7 d白蛋白为（43.3±10.8） g/L,显著高于对照组【（32.4±10.1） g/L,P<0.05】,而两组凝血酶原时间国际标准化比值（INR）分别为【（1.2±0.1）和（1.1±0.2）,P>0.05】;观察组肿瘤完全切除率为94.7%,显著高于对照组的78.1%（P<0.05）;观察组术后12个月肿瘤复发率为7.9%,显著低于对照组的28.1%（P<0.05）。结论 微波消融联合腹腔镜肝切除治疗肝细胞癌合并肝硬化患者疗效显著,安全性高,对于肝功能损伤较小。     

Transanal endoscopic microsurgery: a forgotten minimally invasive technique]

OBJECTIVES: The aim of this study was to evaluate transanal endoscopic microsurgery in patients with benign and malignant rectal tumours with special reference to feasibility, morbidity, and recurrence rate.METHODS: Forty-three patients underwent transanal endoscopic microsurgical excision of rectal tumours between 1996 and 2000. The histological diagnosis was benign adenoma in 30 and invasive carcinoma in 13. The mean height of the tumour above the anal verge was 11.2 +/- 3 cm and the mean diameter of the lesion was 3.4 +/- 1.5 cm.RESULTS: The mean operative time was 85 +/- 26 min and in one case (2%), it was necessary to convert to an anterior resection. The morbidity rate was 18%. Mean hospital stay was 3.9 +/- 2.4 days. Complete excision of the tumour with histological confirmation was achieved in 42 cases (98%). With a mean follow-up of 26 months, benign tumour recurrence was observed in one patient (3%). Of the 13 patients with carcinoma, two had immediate further radical resection. For the remaining 11 patients, with a mean follow-up of 19 months, the recurrence rate was 75% for T2 tumours and nil for T1 tumours.CONCLUSIONS: Transanal endoscopic microsurgery is safe and feasible technique which should have a useful place in the management of sessile adenomas of the mid and upper rectum. Its role in the management of rectal cancer is limited, although it may be appropriate for carefully selected cases.