腹腔镜与结肠镜联合治疗结直肠良恶性肿瘤58例体会

目的 探讨腹腔镜与结肠镜联合治疗结直肠良恶性肿瘤的价值与疗效.方法 回顾分析我院采用腹腔镜与结肠镜联合治疗结直肠肿瘤的病例,比较其疗效、总结经验.结果 纳入研究的58例患者中,结肠镜辅助腹腔镜手术44例,双镜同时治疗5例,腹腔镜辅助结肠镜手术9例,双镜联合治疗手术时间、住院时间均同单一腔镜或结肠镜治疗无差别,而术中并发症大大减少.结论 双镜联合充分发挥微创的最大优势,拓宽结直肠肿瘤微创手术的适应证,更进一步降低了手术的风险.     

腹腔镜和结肠镜双镜联合微创术治疗结直肠良恶性肿瘤的临床疗效观察

目的探讨腹腔镜和结肠镜双镜联合微创术治疗结直肠良恶性肿瘤的临床疗效。方法回顾性分析在我院就诊的良恶性肿瘤140例,根据治疗方法不同分为开腹组(传统开腹术)和双镜组(腹腔镜和结肠镜双镜联合微创术),每组70例。评价两组患者手术时间、术中出血量、术后镇痛药次数、术后肛门排气时间、排便时间、术后引流量、术后引流时间、术后下床活动时间、总住院时间及术后等并发症情况。结果与开腹组相比,双镜组患者手术时间较短,手术出血量和术后引流量较少,术后镇痛次数较少,差异有统计学意义(P0.05);双镜组患者手术后引流时间、肛门排气和排便时间与开腹组相比较短,差异有统计学意义(P0.05)。与开腹组相比,双镜组患者术后下床时间和住院时间较短,差异有统计学意义(P0.05)。双镜组患者术后并发症发生率为2.8%,显著低于开腹组的20.0%,差异有统计学意义(P0.05)。结论腹腔镜与结肠镜的联合微创术具有微创、痛苦小、出血量少、手术时间短、恢复快的优点,除此之外其定位准确、手术成功率高、切除病变完全等优越性是开腹手术不可比拟的,值得进一步的推广应用。     

腹腔镜、结肠镜联合治疗结直肠良恶性肿瘤的应用体会(附21例报告)

目的:探讨腹腔镜、纤维结肠镜联合治疗结直肠良恶性肿瘤的应用价值.方法:回顾分析为21例结直肠良恶性肿瘤患者应用多种双镜联合治疗方法的临床资料.结果:手术均顺利完成,无一例中转开腹.其中内镜辅助腹腔镜治疗12例,腹腔镜辅助内镜治疗4例,内镜腹腔镜同步切除2例,腹腔镜追加根治术3例.术后无吻合口漏、吻合口出血等并发症发生....     

腹腔镜联合结肠镜治疗结直肠息肉的临床研究

目的观察腹腔镜联合结肠镜下手术治疗结直肠息肉的临床效果。方法回顾性分析我院2007年3月至2010年6月收治的45例结直肠息肉患者,所有患者均采取腹腔镜联合结肠镜下手术切除,总结手术方法,观察治疗效果。结果本组45例患者首次手术成功42例,首次手术成功率为93.3%;再次手术成功3例,再次手术成功率为100%;2次手术成功率为100%。手术效果其中痊愈者40例,有效者5例,痊愈率为88.9%,总有效率为100%。术后1个月内出现便血1例,系术中操作不慎引起,无腹泻、腹部压痛和反跳痛以及肠鸣音减弱或消失等并发症发生,手术效果理想。术后2个月复查,除1例因手术操作所引起的并发症外,无复发情况。结论腹腔镜联合结肠镜下手术治疗结直肠息肉效果理想,手术安全性较高,手术中患者痛苦较少,且术后恢复较快,发生并发症几率较小,且易操作,值得临床推广应用。     

结肠镜、腹腔镜联合切除结直肠肿瘤的临床研究

目的:探讨结肠镜与腹腔镜联合切除结直肠肿瘤的临床疗效。方法:经病理诊断为结直肠肿瘤患者24例,按肿瘤良恶性分成A、B两组。A组于腹腔镜监视下,经结肠镜切除直肠腺瘤4例,结肠间质瘤2例,结肠腺瘤样息肉7例。B组在结肠镜指示下,经腹腔镜切除结肠癌7例,直肠癌4例。结果:A组患者平均手术时间为(15±3.4)min,术后发生肠道出血2例,无肠穿孔病例。B组患者均在腹腔镜下完成肿瘤切除术,平均手术时间为(129±17.5)min,术后无切口感染或吻合口漏。A组患者术后第3天痊愈出院,B组术后第9天痊愈出院。结论:结肠镜与腹腔镜联合切除结直肠肿瘤可以优势互补,是安全可行的。     

腹腔镜联合结肠镜治疗复杂、特殊类型的结直肠息肉

目的探讨腹腔镜联合结肠镜治疗结直肠息肉的疗效。方法良性息肉行腹腔镜辅助结肠镜下息肉切除术,腹腔镜辅助结肠镜下息肉切除困难者或有风险者可选用结肠镜辅助腹腔镜下肠段切除术,复杂病例采用混合术式（腹腔镜辅助结肠镜下息肉切除术＋结肠镜辅助腹腔镜下肠段切除术）。结果腹腔镜辅助结肠镜下息肉切除术14例,手术时间55～158min,平均103min。结肠镜辅助腹腔镜下结肠癌根治术2例,手术时间分别为182、206min。结肠镜辅助腹腔镜降结肠部分切除术（降结肠多发息肉,其中1枚息肉为无蒂息肉）1例,手术时间98rain。混合术式2例,手术时间分别为102、166min。19例术后随访10～48个月,平均28个月,无一例息肉残留、复发或再次手术。结论腹腔镜联合结肠镜治疗结直肠息肉疗效满意。     

结肠镜联合腹腔镜下结直肠息肉切除

目的：探讨腹腔镜、结肠镜联合治疗结直肠息肉的手术方式、安全性和可行性。方法：分别采用腹腔镜辅助结肠镜下电凝切除、结肠镜辅助腹腔镜下部分肠壁切除、部分肠段切除及腹腔镜下结肠癌根治等方法,对36例结直肠息肉患者进行治疗。结果：36例均顺利完成手术,无中转开腹。5例在腹腔镜辅助下行结肠镜下息肉切除。22例行结肠镜辅助腹腔镜下部分肠壁切除,其中1例在结肠镜操作过程中发生难于控制的出血,另1例造成穿孔且息肉未完全切除,也行结肠镜辅助的腹腔镜下部分肠壁切除。22例中有18例用Endo-GIA完成。6例行腹腔镜下肠段切除,其中4例因息肉基部广,游离肠段后发现血供差;2例息肉位于直肠上段,且息肉稍大。3例行结肠癌根治术。手术时间70~240 min;手术出血量在20~150 mL;肠功能恢复时间20~48 h。所有患者术后均无肠瘘、肠腔狭窄、术后肠道大出血等并发症发生。结论：结肠镜、腹腔镜联合治疗结直肠息肉,提高了手术的安全性和彻底性,是一种值得推广的微创手术方式。     

结肠镜联合腹腔镜治疗结直肠息肉临床效果比较

目的比较单纯结肠镜与结肠镜联合腹腔镜治疗结直肠息肉的效果。方法随机将38例结直肠息肉患者分成2组,每组19例。观察组采用结肠镜联合腹腔镜手术,对照组采用单纯结肠镜手术。观察对比2组治疗效果。结果 2组手术时间差异无统计学意义(P0.05)。观察组术中出血量、分次切除息肉次数、术后恢复进食时间、抗生素使用时间、并发症发生率、息肉残留例数、术后复发率及再次手术例数,均显著少于对照组,差异有统计学意义(P0.05)。结论结肠镜联合腹腔镜治疗结直肠息肉,可有效降低术中出血量和分次切除次数,缩短肠功能恢复时间和抗生素使用时间,减少术后并发症,降低息肉复发率和再次手术风险。     

腹腔镜联合结肠镜手术治疗直径≤4cm结直肠肿瘤的疗效及安全性

目的探讨腹腔镜联合结肠镜(双镜联合)手术治疗直径≤4 cm结直肠肿瘤的效果及安全性。方法随机将64例结直肠肿瘤患者分为2组,各32例。对照组实施开腹手术,观察组行双镜联合手术。比较2组的疗效。结果观察组手术时间、术中出血量及术后肛门排气时间、下床活动时间、并发症发生率及住院时间均显著低于对照组,差异有统计学意义(P0.05)。结论双镜联合手术治疗直径≤4 cm结直肠肿瘤,能准确定位肿瘤部位,手术时间短、术后并发症发生率低,有利于促进患者术后恢复。     

腹腔镜联合结肠镜在结直肠息肉切除术中的应用

目的探讨腹腔镜联合结肠镜在结直肠息肉切除术中的应用效果。方法选取2016年12月至2019年12月本院采取腹腔镜联合结肠镜下行结直肠息肉切除术治疗的结直肠息肉患者68例,观察手术的情况和并发症情况。结果 68例患者手术均顺利完成,平均手术时间为(68.18±18.03)分钟、手术出血量(49.12±5.37)毫升、术后VAS评分(2.12±0.74)分,术后均未出现肠梗阻、出血、肠穿孔等并发症。结论腹腔镜联合结肠镜在结直肠息肉切除术中的效果显著,手术时间短,手术出血量低,术后无明显疼痛,并发症少。     

腹腔镜术中联合结肠镜治疗结直肠小占位病变的体会

目的探讨腹腔镜术中联合结肠镜治疗结直肠小占位病变的可行性和临床应用价值。方法对我院2006年12月至2009年5月期间23例行腹腔镜联合结肠镜手术的结直肠小占位病变患者的临床资料进行回顾性分析。结果所有患者均在腹腔镜下完成手术,无中转开腹。手术时间80~200 min,平均140 min;出血80~120 ml,平均100 ml。9例息肉病变行局灶切除,术中经快速冰冻切片病理证实4例早期癌及10例不典型增生均行相应肠段切除。术后1例出现轻度肺炎,经积极抗炎对症治疗后痊愈,其余患者恢复良好。所有患者术后第1天即离床活动,住院时间5~10 d,平均7 d。结论腹腔镜术中联合结肠镜治疗结直肠占位是安全可行的,有助于结直肠病灶及切缘的准确定位,可缩短手术时间,值得临床进一步推广应用。     

腹腔镜联合结肠镜手术治疗结直肠小占位(≤3cm)病变

目的探讨腹腔镜联合结肠镜治疗结直肠小占位(≤3 cm)病变的临床效果。方法 2010年1月~2015年1月我院采用腹腔镜联合结肠镜手术治疗小占位结直肠肿瘤41例,结肠镜进行全结直肠内探查,在结肠镜下注射亚甲蓝进行染色,腹腔镜下进行局部钛夹定位,退出结肠镜,术中根据快速冰冻病理结果选择在腹腔镜下肠管切除、结直肠根治术等相应手术。结果 41例均顺利完成腹腔镜联合结肠镜手术,无中转开腹。9例术前诊断为癌前病变,术中及术后病理诊断为结肠上皮内瘤变6例,Tis期腺癌3例。32例术前诊断为0~Ⅰ期结直肠癌者,术中及术后诊断Ⅰ期29例,其中T_1N_0M_0期腺癌23例,T_2N_0M_0期腺癌6例;Ⅲ期3例,均为T_2N_1M_0期腺癌。多发病灶2例。结肠上皮内瘤变及Tis期结直肠肠癌行病变肠管切除,T_1~T_2期结直肠癌均行结直肠癌根治术。2例结肠上皮瘤变分别在术后9、12个月随访无复发。其余39例随访24~49个月,中位时间38.6月,35例结直肠癌中,1例T_2N_1M_0即Ⅲ期腺癌术后34个月结肠镜复查局部复发,所有患者均无转移。结论腹腔镜联合结肠镜治疗≤3 cm良性及Tis~T_2期恶性结直肠肿瘤,可发挥双镜优势,尤其适用于单镜难以定位或完全切除的病变,可提高定位精确性及手术安全性。     

腹腔镜联合结肠镜治疗结直肠癌的疗效观察

探讨腹腔镜联合结肠镜治疗结直肠癌的临床疗效。260例结直肠癌患者随机分为研究组与对照组,每组130例。对照组单纯应用腹腔镜手术治疗,研究组应用腹腔镜联合结肠镜手术治疗。研究组术中出血量、引流管留置时间及住院时间均少于对照组(P0.05)。手术时间与对照组相比差异无统计学意义(P0.05)。研究组4例患者出现术后并发症,占3.08%;对照组5例患者出现术后并发症,占3.85%,两组并发症发生率比较差异无统计学意义(P0.05)。研究组局部复发率、远处转移率和3年生存率分别为3.1%、4.6%、87.7%;对照组局部复发率、远处转移率和3年生存率分别为3.8%、3.8%、85.4%。两组局部复发率、远处转移率和3年生存率比较差异无统计学意义(P0.05)。腹腔镜联合结肠镜能够准确定位结直肠癌,减少术中出血量和引流管留置时间,缩短患者住院时间,具有推广价值。     

腹腔镜、结肠镜联合手术治疗结直肠小病灶(直径≤3.5cm)肿瘤

目的探讨腹腔镜、结肠镜双镜联合加术中快速冰冻病理检查在结直肠小病灶(直径≤3.5 cm)肿瘤治疗中的临床应用价值。方法回顾性分析我院2012年5月~2015年4月应用腹腔镜、结肠镜联合加术中快速冰冻病理检查治疗结直肠小病灶肿瘤36例的临床资料。肿瘤位于直肠3例,乙状结肠9例,降结肠11例,横结肠4例,升结肠9例。肿瘤大小1.0 cm×1.5 cm~3.5 cm×3.5 cm。腹腔镜、结肠镜联合精确定位肿瘤位置后,腹腔镜下切除肿瘤送全瘤术中冰冻病理检查,根据冰冻病理结果腹腔镜下完成肠切除术或肠癌根治术。结果 36例手术均获得成功。3例术前局部活检病理示绒毛状腺瘤伴重度非典型增生,术中快速冰冻病理检查全瘤活检示腺癌。17例管状绒毛状腺瘤伴轻度(9例)或中度(8例)非典型增生行肠壁并息肉楔形切除术,5例管状绒毛状腺瘤伴轻度(2例)或中度(3例)非典型增生及3例绒毛状腺瘤伴重度非典型增生行部分肠管切除术,2例绒毛状腺瘤伴重度非典型增生行肠管切除加局域淋巴结清扫术,9例腺癌行肠癌根治术。无术后吻合口出血、吻合口狭窄、吻合口漏、腹腔内感染。术后随访6~36个月,平均20.5月,未发现肿瘤复发、远处转移及切口种植。结论应用腹腔镜、结肠镜双镜联合加术中快速冰冻病理检查治疗结直肠小病灶肿瘤安全,高效,微创。     

结直肠良、恶性息肉微创治疗的临床研究

目的探讨结肠镜、腹腔镜及双镜联合治疗结直肠息肉的适应证和疗效。方法2004年1月～2006年12月，全结肠镜愉奄发现直径〉1cm的结直肠息肉共378例。结肠镜圈套器摘除319例，结肠镜黏膜切除术（endoscopic mucosal resection，EMR）11例，腹腔镜辅助结肠镜下治疗7例，结肠镜辅助腹腔镜楔形切除术6例，结肠镜辅助腹腔镜肠段切除术3例，腹腔镜结直肠癌根治术32例。结果腹腔镜辅助结肠镜治疗组与结肠镜辅助腹腔镜局部切除术组均未出现一例并发症，结肠镜圈套器摘除组中1．6％（5／319）出现并发症。结肠镜组肿瘤残留11例，追加腹腔镜结直肠癌根治术8例。随访中，EMR术1例肿瘤残留，追加腹腔镜结直肠癌根治术。结肠镜辅助腹腔镜楔形切除术中2例为浸润性结直肠癌，追加腹腔镜结直肠癌根治术。结论大部分结直肠良性息肉可以通过单纯结肠镜的方法得到治疗；双镜联合的治疗方式对于结肠镜治疗困难的结直肠息肉是安全、可行的治疗方法。     

经肛门内镜联合腹腔镜治疗结直肠肿瘤

目的探讨经肛门内镜联合腹腔镜治疗直肠和乙状结肠肿瘤的可行性及近期疗效。方法回顾性分析2010年5月至2011年5月间在上海交通大学医学院附属瑞金医院接受经肛门内镜联合腹腔镜手术治疗的26例直肠和乙状结肠肿瘤患者的临床资料。结果26例患者均在腹腔镜下成功完成手术,无中转开腹,均未行保护性末端回肠造口。手术时间为（151．6±25．9）min,术中失血量为（200．2±114．7）ml,术后排气时间为（2．0±0．5）d。肿瘤大小为（3．0±0．7）cm,所有手术切缘均阴性,淋巴结检出数为（12．9±2．2）枚。术后有6例患者出现吻合口瘘,均为低位直肠肿瘤患者,其中5例出现于前15例患者中,后11例患者仅1例出现吻合口瘘。全组无输尿管损伤、术后肠梗阻及肺部感染病例。结论经肛门内镜联合腹腔镜技术治疗结直肠肿瘤是一种安全、有效的微创手术方式．是将腹腔镜技术与经自然腔道手术概念相结合的一种进步。     

腹腔镜结直肠手术治疗结直肠肿瘤的临床应用

目的:探讨腹腔镜结直肠手术的临床应用价值。方法:分析运用腹腔镜技术,按开放手术原则治疗结直肠癌70例的临床资料,其中右半结肠切除术2例,乙状结肠切除术7例,直肠癌行直肠前切除术(Dixon术)52例,Miles术9例。结果:69例手术成功,1例因侵及膀胱后壁转开腹手术。平均手术时间140min,术中平均失血100ml。术后肠蠕动恢复平均1.6d,5例术后性功能障碍,4例术后早期排尿障碍。无术后出血、吻合口瘘等并发症。随访1~39月,2例腹腔内广泛转移,2例肝脏转移,1例穿刺孔种植转移。结论:腹腔镜结直肠手术安全可行,严格掌握手术适应证、熟练的腹腔镜手术技术和丰富的开腹结直肠手术经验是完成此类手术的关键。     

老年患者腹腔镜结直肠手术的安全性研究

Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.     

老年患者腹腔镜结直肠手术的安全性研究

Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.     

老年患者腹腔镜结直肠手术的安全性研究

Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.