腹腔镜结直肠肿瘤切除术的难点及对策(附83例报告)

目的:探讨腹腔镜结直肠肿瘤切除的常见难点及对策。方法:回顾分析2005年2月至2007年6月83例腹腔镜结直肠肿瘤切除术患者的临床资料。结果:74例手术成功,9例中转开腹。手术并发症是皮下气肿5例(6.0%)、不完全性肠梗阻5例(6.0%)、术后大出血1例(1.2%)、肠管损伤3例(3.6%)、吻合口漏1例(1.2%)等。结论:腹腔镜结直肠肿瘤切除术的常见难点为血管的识别及处理、脏器损伤特别是输尿管及肠管损伤的预防及手术操作面的显露等。正确的解剖入路、开腹手术经验丰富及良好的腹腔镜培训可减少手术并发症的发生。

Difficulty analysis and measures of laparoscopic resection for colorectal carcinoma:with a report of 83 cases

Objective:To explore the difficulty analysis and measures of laparoscopic resection for colorectal carcinoma.Methods:The clinical data of 83 cases of laparoscopic resection for colorectal carcinoma from Feb.2005 to Jun.2007 were reviewed retrospectively.Results:There were 74 patients treated successfully by laparoscopic resection,9 cases were converted to open surgery.Operative complications were cutaneous emphysema and hypercapnia in 5 cases(6.0%),incomplete intestinal obstruction in 5 cases(6.0%),postoperative abdominal hemorrhea in 1 case(1.2%),intestinal damage in 3 cases(3.6%) anastomotic leak in 1 case(1.2%).Conclusions:The common nodus of laparoscopic resection for colorectal carcinoma contain identifying and handling blood vessel,prevention from organ injuries especially ureter and intestinal canal,identifying and exposing the operative planes.Correct anatomic approach,practised experience of open operation,good training of laparoscopic technique and essential operating skills are operative guarantee and keys to reduce the complications.