腹腔镜辅助次/全结-直肠切除的临床应用

目的探讨腹腔镜辅助次／全结一直肠切除术的安全性及可行性。方法2003年3月～2005年11月。行腹腔镜辅助次／全结一直肠切除术8例。年龄33—65岁，中位数44岁，包括结一直肠多发肿瘤1例、溃疡性结肠炎3例、家族性息肉病2例，慢传输性便秘2例。行回肠储袋一肛管吻合3例、回肠储袋一直肠吻合3例、盲肠一直肠吻合2例。预防性回肠造瘘5例。结果8例均在腹腔镜协助下完成，无中转开腹，无死亡病例。手术时间5．5—7．5h，中位数6h。术中出血量150—400ml，中位数200ml，无术中、术后输血。术后48h进食。8例随访4～31个月，中位数25个月。腹腔内残余感染1例（溃疡性结肠炎），吻合口狭窄1例（家族性息肉病）。结论腹腔镜辅助次／全结一直肠切除术能够安全、有效进行。

A clinical application of laparoscopic total/subtotal proctocolectomy

Objective To investigate the safety and feasibility of laparoscopic total/subtotal proctocolectomy. Methods Laparoscopic total/subtotal proctocolectomy was performed in 8 cases from March 2003 to November 2005, including 1 case of multiple colorectal tumors, 3 cases of ulcerative colitis, 2 cases of familial adenomatous polyposis, and 2 cases of slow transit constipation. The operation included ileal pouch-anal canal anastomosis in 3 cases, ileal pouch-rectum anastomosis in 3 cases, and cecum-rectum anastomsis in 2 cases. A prophylactic ileostomy was conducted in 5 cases. Results The operation was laparoscopically conducted in all the 8 cases, without conversions to open surgery. No fatal case was encountered. The operative time was 5.5~7.5 h (median, 6 h). The intraoperative blood loss was 150~400 ml (median, 200 ml). There was no intra- or post-operative blood transfusion. The patients began to take diet at 48 h postoperatively. Follow-up observations in 8 cases for 4~31 months (median, 25 months) showed 1 case of intraabdominal infection and 1 case of anastomsis stenosis. Conclusions Laparoscopic total/subtotal proctocolectomy is safe and feasible.