腹腔镜左半结肠癌根治性切除术的手术体会

目的:探讨腹腔镜左半结肠癌根治性切除术的临床疗效及操作体会。方法:回顾分析2015年9月至2016年7月11例患者行腹腔镜下标准左半结肠癌根治术的临床资料,采用五孔法中间入路,操作过程中严格遵循层面间隙内游离及结肠恶性肿瘤根治原则。结果:11例患者均顺利完成标准腹腔镜辅助左半结肠癌根治术,手术时间平均(142.25±35.26)min,术中出血量平均(21.53±8.76)ml,清扫淋巴结数量平均(18.45±4.28)枚,肛门排气时间平均(30.48±8.23)h,平均住院(10.23±5.26)d。术后无切口愈合不良表现,术后出现肺部感染1例,腹腔感染1例,吻合口瘘1例,经营养支持、消炎、引流等保守治疗后痊愈,术后肠梗阻1例,保守治疗成功,术后1例发生腹腔内出血,再次行腹腔镜探查,发现为胰腺尾部创面边缘出血,行止血治疗。无围手术期死亡病例,患者均获随访,未发现切口肿瘤种植。结论:只要熟悉各个解剖层次,术中保持层面间隙内游离,避免过度牵拉,腹腔镜辅助左半结肠癌根治术是安全、有效的。

Surgical experience of laparoscopic left hemicolectomy for colon carcinoma

Objective:To explore the clinical effect and surgical experience of laparoscopic left hemicolectomy for colon carcinoma.Methods:The clinical data of 11 patients who underwent laparoscopic left hemicolectomy for colon carcinoma from Sep.2015 to Jul.2016 were retrospectively analyzed.Five-port method and medial approach was used.The standard of colonic radical resection for cancer and separation in the gap were strictly followed in the operation.Results:Eleven patients successfully underwent standard laparoscopic-assisted left hemicolectomy for colon carcinoma.The mean operation time was (142.25 ± 35.26) min,the blood loss was (21.53 ±8.76) ml,the number of dissected lymph nodes was (18.45 ± 4.28),the average time for flatus and hospital stay was (30.48 ± 8.23) h and (10.23 ± 5.26) d respectively.No poor healing of incision occurred.Postoperative complications included pulmonary infection (n =1),abdominal infection (n =1),anastomotic fistula (n =1),ileus (n =1) and abdominal cavity hemorrhage (n =1).Postoperative ileus was cured after conservative treatment.The patient with abdominal cavity hemorrhage underwent re-laparoscopic exploration and hemostasis because of hemorrhage at wound edge of pancreatic tail.The other complications were cured after conservative treatment such as nutrition support,anti-inflammation,drainage and so on.No death occurred in the perioperative period.No port-site recurrence was found during follow-up.Conclusions:Laparoscopic-assisted left hemicolectomy for colon carcinoma is safe and effective if surgeons are familiar with anatomical level,separate in gap and avoid excessive traction.