经脐单子L腹腔镜结直肠手术的临床应用

目的探讨经脐单孔腹腔镜结直肠手术的临床应用价值。方法回顾性分析2010年1月至2012年12月自贡市第四人民医院收治的25例结肠、直肠上段良恶性肿瘤行手术切除患者的临床资料。根据病变的部位和性质确定手术方案。采用门诊和电话随访，随访时间截至2013年3月。结果25例患者中行结直肠部分切除术14例，根治性右半结肠切除术1例，横结肠癌根治术1例，根治性左半结肠切除术1例，乙状结肠癌根治术2例，直肠癌根治术6例。22例患者成功施行经脐单孔腹腔镜结直肠手术，2例改为“四孔法”手术，1例中转开腹手术。单孔腹腔镜手术中位切口长度为3．8cm（3．5～4．5cm），手术时间为（192±32）min，术中出血量为（61±21）mL，肿瘤中位长径为2．7cm（1．0～5．0cm），中位淋巴结清扫数目为7枚（3～22枚），术后平均肛门排气时间为2d（1—5d），术后平均住院时间为8d（6～20d）。患者术后并发症发生率为8．0％（2／25），包括切口感染1例，吻合口漏1例。11例行根治手术的患者肿瘤环周切缘均为阴性。22例行经脐单孔腹腔镜结直肠手术的患者均接受随访，中位随访时间为12个月。1例结肠癌患者术后10个月发现肝转移，其余患者均无瘤生存。结论经脐单孔腹腔镜结直肠手术安全可行，创伤小、恢复快、并发症少、切口美观。

Clinical application of transumbilical single-port laparoscopic colorectal operation

Objective To investigate the clinical value of transumbilical single-port laparoscopic colorectal operation. Methods The clinical data of 25 patients with benign or malignant carcinoma at the upper part of the colon or rectum who were admitted to the No. 4 People＇s Hospital of Zigong from January 2010 to December 2012 were retrospectively analyzed, and the clinical experience of transnmbilical single-port laparoscopic colorectal operation was summarized. Surgical procedure was selected according to the position and nature of the lesion. Patients were followed up via out-patient examination and phone call till March 2013. Results Partial colorectal resection was done on 14 patients, radical resection of right colon on 1 patient, radical resection of transverse colon on 1 patient, radical resec- tion of left colon on 1 patient, radical resection of sigmoid colon on 2 patients and radical rectectomy on 6 patients. The operation was successfully carried out on 22 patients, 2 patients received four-port laparoscopic colorectal operation, and 1 patient was converted to open surgery. The median length of the incision of single-port laparoscopie colorectal operation was 3.8 cm （ range, 3.5-4.5 cm） , and the operation time was （ 192 ＋ 32） minutes. The intraoperative blood loss was （61 _＋21 ）mL, and the median diameter of the tumor was 2.7 cm （range, 1.0-5.0 cm）. The median number of lymph nodes dissected was 7 （range, 3-22） , the mean time of postoperative anal exhaust time was 2 days （range, 1-5 days） , and the mean time of postoperative hospital stay was 8 days （range, 6-20 days）. The incidence of postopera- tive complications was 8.0% （ 2/25 ）, including 1 patient with wound infection and 1 patient with anastomotic leakage. The circumferential resection margins of radically resected specimens were negative in 11 patients. Twenty-two patients who received transumbilical single-port laparoseopic colorectal resection were followed up, and the median time of follow-up was 12 months. Colorectal liver metastasis was detected on 1 patient at postopera- tive month 10, and the other patients survived without tumor recurrence or metastases. Conclusions Transumbilical single- port laparoscopic coloreetal operation is safe, micro-traumatic and feasible, and it also has less complication and good cosmetic effect.