术中结肠镜检在腹腔镜结直肠肿瘤切除术中的应用

目的 探讨术中结肠镜在腹腔镜结直肠肿瘤切除术中的临床应用价值.方法 对28例结直肠肿瘤患者施行腹腔镜结直肠肿瘤切除术时,术中使用结肠镜对肿瘤定位以确定切缘,肠管吻合后使用结肠镜观察吻合口有无吻合口漏及吻合口出血,并对并存结直肠息肉行结肠镜下切除.结果 28例均成功完成定位和手术,无中转开腹.平均手术时间190(120-230)min,术后平均住院天数9.5(7-12)d.术中结肠镜检发现吻合口出血和吻合口漏各1例,近端结肠腺瘤性息肉3例.术后并发症主要为1例切口脂肪液化,无吻合口漏和狭窄,无吻合口出血,术后病理标本残端无肿瘤细胞残留、浸润.结论 在腹腔镜结直肠肿瘤切除术中应用肠镜能快速、精确确定切除范围,弥补了腹腔镜手术的缺陷,减少腹腔肿瘤细胞脱落,肿瘤根治彻底,可靠观察吻合口情况,有效预防和治疗吻合日出血和吻合口漏的发生,值得临床推广.

Application of colonoscopy in laparoscopic resection of colorectal neoplasms

Objective: To explore the clinical value of colonoscopy in laparoscopic resection of colorectal neoplasms.
Methods: A total of 28 patients with colorectal neoplasms underwent laparoscopic resection. All patients received colonoscopy for neoplasm localization, and to observe anastmotic leakage and anastmotic bleeding after anastomosis,and any concomitant colorectal polyps were treated by local excision via colonoscopy.
Results: All lesions were successfully oriented and resected. There weve no conversions to open surgery. The mean operation time was 190(120-230)minutes, and the average postoperative hospital stay was 9.5(7-12)days. The intraoperation colonoscopy discovered anastmotic leakage（n=1）,anastmotic bleeding（n=1）and proximal colon adenomatous polyps（n=3）. The main  postoperative complication only occurred in one case of fat liquefaction of abdominal incision; there was no bleeding, leakage or stenosis of anastomosis postoperatively. Postoperative pathological examination revealed no residual tumor or infiltration of tumor cells in resection margin.
Conclusions: Colonoscopy could quickly and accurately determine the extent of neoplasms during  laparoscopic resection of colorectal neoplasms, and fill up a shortcoming in laparoscopic resection.It could decrease exfoliation of tumor cells into abdominal cavity,tumors can be completely and radically removed, the anastomotic sites can be accurately observed, and bleeding or leakage of anastomosis can be effectively prevented and treated. This method is worthy of widespread application.