腹腔镜直肠癌根治手术56例临床研究

目的从手术路径、手术技巧、造瘘及吻合等方面分享腹腔镜直肠癌根治手术技巧经验。 方法回顾性分析安徽省淮南新华医院2015年1月到2016年9月成功开展的56例行腹腔镜直肠癌根治患者临床资料，结合手术体验探讨手术体会及技巧。 结果56例患者手术及麻醉过程顺利，均采用标准腹腔镜直肠癌根治术，包括腹会阴联合直肠癌根治术（Miles）17例（30.36%）；经腹直肠癌切除术（Dixon）35例（62.50%），其中6例行预防性末端回肠造口术；经腹直肠癌切除、近端造口、远端封闭手术（Hartmann）4例（7.14%）。腹腔镜手术时间为120~230（162±43）min，出血量为10~400（74±50.5）ml。术后病理：Ⅱ期19例，Ⅲ期35例，Ⅳ期2例。术后2例（3.57%）出现肠梗阻，保守治疗治愈，3例（5.36%）切口感染，1例（1.78%）肺部感染，予以相应处理后痊愈出院。随访12~34个月，未见复发病例。 结论腹腔镜直肠癌根治手术路径及技巧各异，在遵循肿瘤手术一般原则及操作熟练的情况下，具有安全有效、微创精细、精准等优势。

Clinical study of laparoscopic radical resection for rectal cancer: a report of 56 cases

ObjectiveTo share the experience of laparoscopic radical resection for rectal cancer from the aspects of surgical procedures, surgical techniques, fistulas and anastomosis. MethodsFrom January 2015 to September 2016, the clinical data of fifty-six cases undergoing laparoscopic rectal cancer resection in Xinhua Hospital of Huainan City were analyzed retrospectively. ResultsThe laparoscopic radical resection and anesthesia process were smooth in the 56 patients. There were 17 cases (30.36%), 35 cases(62.50%), and 4 cases(7.14%) performed by Miles, Dixon and Hartmann operation, respectively, including 6 cases of prophylactic terminal ileostomy in the Dixon group. The laparoscopic operation time was 120-230 (162±43) min, the amount of bleeding was 10-400 (74±50.5) ml. Postoperative pathology showed 19 cases in stage Ⅱ, 35 in stage Ⅲ, and 2 in stage Ⅳ. Postoperative complications found 2 (3.57%) of intestinal obstruction, 3 (5.36%) of incision infection, and 1 (1.78%) of pulmonary infection. All cases were cured and discharged. No recurrence was found after 12-34 months of follow-up. ConclusionsThe path and skills of laparoscopic colorectal cancer is not exactly the same. Following the basic principles and skills of tumor surgery, laparoscopic colorectal cancer surgery is safe, effective, minimally invasive, and precise.