悬吊式免气腹腹腔镜结直肠癌根治术的临床应用

目的探讨悬吊式免气腹腹腔镜结直肠癌根治手术的可行性。方法 2008年5月～2009年10月,行悬吊式免气腹腹腔镜结直肠癌根治手术43例,其中右半结肠癌根治术10例,横结肠癌根治术3例,左半结肠癌根治术9例,直肠癌Dixon手术16例,直肠癌Miles手术5例。术后37例行FOLFOX辅助化疗方案。结果 43例手术均成功完成,无中转开腹,无死亡病例。手术时间:右半结肠切除术180～300min(平均240min),左半结肠切除术120～240min(平均180min),Dixon手术120～210min(平均150min),Miles手术170～210min(平均190min)。术中出血150ml。手术切除淋巴结10～28个,平均16个,其中阳性5个。术后恢复顺利。43例随访4～10个月,平均7个月,未见切口种植及吻合口复发,腹部CT检查未发现远处转移。结论悬吊式免气腹腹腔镜结直肠癌根治手术避免了气腹对人体血流动力学的影响,是一种安全、可行、经济的手术方法 。

Gasless Laparoscopic Radical Resection by Using Abdominal Wall Lifting Technique for Colorectal Cancer

Objective To evaluate the feasibility of gasless laparoscopic radical resection for colorectal cancer by abdominal wall lifting method. Methods The clinical data of 43 cases that were treated with gasless laparoscopic radical resection with abdominal wall lifting method from May 2008 to October 2009 were included in this study. Among the cases, 10 patients received radical right colectomy, 3 underwent radical transverse colectomy, 9 received radical left colectomy, 16 underwent Dixon surgery, and 5 Miles operation. After the operations, FOLFOX adjuvant chemotherapy was carried out in 37 of the patients. Results The surgeries were completed successfully in all of the patients without conversion to open surgery or intraoperative death. The operation time ranged from 180 to 300 minutes with a mean of 240 minutes for radical right colectomy, 120-240 minutes （mean, 180 minutes） in radical left colectomy, 120-210 minutes （mean, 150 minutes） in Dixon operation, and 170-210 minutes （mean, 190 minutes） in Miles operation. In none of the patients, the intraoperative blood loss was more than 150 ml. During the surgeries, a mean of 16 lymph nodes were resected in the patients （ranged from 10 to 28）, and the mean number of positive lymph nodes was 5. Follow-up was carried out in all of the cases for 4 to 10 months （mean, 7 months）, during which no incisional implantation or anastomotic recurrence occurred, meanwhile no distant metastasis was detected by abdominal CT. Conclusions Gasless laparoscopic radical resection by abdominal wall lifting method is a safe, feasible, and economic method for colorectal cancer. By using the method, the influence of pneumoperitoneum on the homodynamics can be avoided.