手助腹腔镜行结直肠癌切除术14例报告

目的：探讨采用手助腹腔镜（HALS）行大肠癌切除术的疗效。方法：对14例结、直肠癌患者,采用HALS行结、直肠癌切除术。结果：8例右半结肠癌中,6例采用HALS完成手术切除,手术时间为110－220min(平均160min),术中失血40－100ml,术后36－72h恢复肠鸣音,7－12d出院（平均8d）,并均按综合治疗计划行术后化疗;另2例中转开腹。6例下段直肠癌行腹会阴联合根治切除术中,5例采用HALS完成手术,手术时间为120－270min(平均180min),术中腹腔内失血40－80ml,术生24－72h恢复肠鸣音,12－18d出院（平均14d),患者均在术后7－8d拔除导尿管自行排尿,并按计划放、化疗;另1例因广泛盆腔粘连中转开腹。本组11例采用HALS行大肠癌根治术不仅达到了开腹根治术的要求,而且具备操作安全、简捷、微创、恢复快的优点,有利于患者免疫机能的恢复和术后生活质量的提高。但HALS行大肠癌根治术的远期疗效有待进一步观察。

Hand-assisted laparoscopic surgery in colorectal carcinoma resection: a report of 14 cases

OBJECTIVE: To study the application of hand-assisted laparoscopic surgery (HALS) in colorectal carcinoma resection. METHODS: Fourteen patients with colorectal carcinoma underwent resection by HALS. RESULTS: Hand-assisted laparoscopic right hemicolectomy was performed in 6 of 8 ascending colon cancer patients, spending an average of 160 minutes (110 to 220 minutes) for the procedure. The amount of bleeding was 40 approximately 100 ml. Bowel sounds resumed in 36 approximately 72 hours after the operation. The average interval between the operation and patients' discharge was 8 days (7 to 12 days). For 2 patients the surgeons had to resort to laparotomy. All patients received postoperative chemotherapy. Hand-assisted laparoscopic abdominoperineal resection was performed in 5 of 6 patients with lower rectal cancer, with the average duration of 180 minutes (120 to 270 minutes), with bleeding of 40 to 80 ml. Bowel sounds resumed within 24 to 72 hours and the average discharge interval was 14 days (12 to 18 days). The urinary catheter in 6 patients was removed in 7 to 8 days after the operation. All patients with rectal carcinoma received postoperative chemotherapy and radiotherapy. One patient was shifted to laparotomy because of extensive adhesion in the pelvic cavity. Four of 11 patients treated by HALS experienced slight pain in the incision. No other complications were observed in any of the patients. Remote results await further follow-up. CONCLUSION: Hand-assisted laparoscopic surgery in the treatment of colorectal carcinoma, a safe and simple procedure, not only ensures the clearance of tumor, but also reduces operative trauma and hastens recovery.