腹腔镜联合辅助化疗及内镜治疗进展期结直肠癌合并腺瘤的应用研究

目的：探讨腹腔镜结直肠癌切除术加辅助化疗加二期内镜下治疗结直肠癌合并根治术切除范围外结直肠腺瘤的临床应用价值。方法：2005年1月-2010年6月对54例进展期结直肠癌合并根治术切除范围外结直肠腺瘤（〉1．0cm）的患者（研究组）行腹腔镜结直肠癌切除术加辅助化疗（FOLFOX4方案）加二期内镜下腺瘤切除的综合治疗,对同期396例单发进展期结直肠癌患者（对照组）行腹腔镜结直肠癌切除术加辅助化疗（FOLFOX4方案）。通过并发症发生率、长期随访等评价治疗效果。结果：2组患者在年龄、性别、手术方式、手术时间、术中出血量、并发症发生率、平均住院时间、肿瘤大小、淋巴结转移、TNM分期及1、3和5年存活率差异无统计学意义（P〉O．05）。研究组辅助化疗后对合并腺瘤进行内镜下切除治疗,4例出血经保守治疗后成功止血,未发生穿孔、狭窄等严重并发症;3例患者术后病理组织学检查为腺瘤癌变,其中2例癌变局限于腺瘤中,1例癌细胞侵犯达黏膜下层,该例患者再次行腹腔镜下切除,术后随访无复发。结论：腹腔镜联合辅助化疗及内镜为合并结直肠癌根治术切除范围外腺瘤的患者提供了一种安全有效的微创治疗方法,值得临床推厂和应用。     

镍钛记忆合金支架与腹腔镜手术联合治疗结直肠癌伴肠梗阻34例分析

目的探讨结直肠癌伴肠梗阻微创治疗新方法。方法对结直肠癌伴肠梗阻34例患者,先在结肠镜引导下置入记忆合金肠道支架解除梗阻,再经充分肠道准备后,腹腔镜下施行根治性切除手术。结果 34例患者手术时间160～340min,平均210min;术后胃肠功能恢复时间2～4d,平均2.1d。术后出现吻合口漏1例,切口感染2例,经保守治疗治愈。TNMⅡ期患者5例,术后住院7～12d,平均8.2d;Ⅲ～Ⅳ期患者29例,术后5-FU/LV或FOLFOX4方案化疗。随访26例,时间3～36个月,平均15个月,1例死于广泛转移,其他25例无局部复发、切口肿瘤种植及吻合口狭窄。结论记忆合金支架与腹腔镜手术联合治疗结直肠癌伴肠梗阻具有微创、安全、恢复快、疗效好等优点,值得临床推广应用。     

结肠镜在腹腔镜结直肠手术中的应用(附24例报告)

目的 探讨结肠镜在腹腔镜结直肠手术中的应用价值.方法 回顾分析2009年1月至2013年10月为24例患者于腹腔镜术中应用纤维结肠镜辅助定位的临床资料.结果 手术均顺利完成,无一例中转开腹.其中内镜辅助腹腔镜治疗15例,腹腔镜辅助内镜治疗4例,内镜腹腔镜同步切除2例,腹腔镜追加根治术3例.术后无吻合口漏、吻合口出血等并发症发生.术后平均随访18个月,恶性肿瘤患者中无一例复发.结论 双镜的联合应用扩展了单镜治疗的适用范围.增加了手术安全性,明显降低了并发症的发生率,大大减少了手术创伤,是治疗结直肠良恶性肿瘤的合理方法,值得推广.     

腹腔镜手术治疗结直肠肿瘤的临床应用价值

目的:探讨腹腔镜手术治疗结直肠肿瘤的应用价值。方法:回顾分析腹腔镜手术治疗99例结直肠肿瘤患者的临床资料。结果:97例成功完成腹腔镜手术,2例中转开腹。平均手术时间167min,术中平均出血100ml,术后平均2.6d恢复肠蠕动。随访5~29个月,无切口及穿刺孔种植转移。结论:腹腔镜结直肠肿瘤手术安全可行,符合肿瘤根治原则,近期疗效满意。     

腹腔镜结直肠手术的临床应用

目的总结腹腔镜结直肠手术的临床应用经验. 方法运用腹腔镜技术,按开放手术原则治疗结直肠癌32例,其中右半结肠切除术2例,乙状结肠切除术2例,直肠癌行直肠前切除术(Dixon术式)19例,Miles术式9例. 结果 31例手术成功,1例上段直肠癌因侵及膀胱后壁中转开腹手术.手术时间110～210 min,平均160 min.术中出血量40～300 ml,平均150 ml.术后1～3 d肠蠕动恢复,平均1.6 d.无术后出血、吻合口漏、尿潴留等并发症,2例术后性功能障碍.术后住院5～8 d,平均7 d.随访32例,时间1～18个月,平均6个月,1例腹腔内广泛转移. 结论腹腔镜结直肠手术安全可行.严格掌握手术适应证、熟练的腹腔镜手术技术和丰富的开腹结直肠手术经验是完成此类手术的关键.     

腹腔镜辅助下结直肠癌切除手术的临床应用

目的 探讨腹腔镜辅助下结直肠癌切除手术的可行性和应用价值.方法 回顾性分析51例腹腔镜结直肠癌切除手术的临床资料.腹腔镜下完成结直肠手术48例,中转开腹3例.其中右半结肠切除术9例,左半结肠切除术8例,乙状结肠切除术14例,直肠前切除术11例,腹会阴联合根治术6例.结果 全组无手术死亡.腹腔镜手术时间150～320（平均195）min,术中出血40～300（平均120）Ml,手术清除淋巴结2～26（平均8）枚.术后20～72h均恢复胃肠功能,术后疼痛轻,无术中大出血、术后无特殊并发症发生.术后住院时间（不包括化疗）7～10（平均8）d.随访45例（88.2%）,随访时间3～54个月,2例死亡,均为Dukes C期直肠癌患者,1例术后17个月死于肝转移,另1例术后19个月死于腹腔广泛转移并衰竭.未发现套管穿刺部位及辅助小切口处肿瘤种植和局部复发.结论 腹腔镜结直肠癌手术在应用技术上可行,且具有创伤小、痛苦少、恢复快等特点,是治疗结直肠癌的一种微创、安全而有效的术式.     

腹腔镜辅助结直肠手术的临床分析

目的:总结腹腔镜辅助结直肠手术的处理经验。方法:总结2003年1月至2007年10月我院腹腔镜辅助结直肠手术的经验,患者病变位于腹膜返折上方,资料完整者154例,分为早期组62例(2006年前)及后期组92例(2006年后),比较两组患者的基本情况、手术时间、术中出血、淋巴结清扫、术后并发症发生及中转开腹等情况。结果:两组患者基本情况无明显差异,后期组手术时间、术中出血、术后平均住院天数少于早期组,2组间并发症比较无差异,总体并发症发生率10.53%,围手术期死亡率1.30%,中转开腹2例。结论:腹腔镜辅助结直肠手术是安全有效的外科治疗手段。     

电钩法腹腔镜结直肠肿瘤手术的应用体会

目的:对比开放手术与电钩法腹腔镜结直肠肿瘤手术的治疗效果,探讨更合理的手术方案。方法:随机将60例活检病理确诊的结直肠癌患者平均分为两组,研究组行电凝钩法腹腔镜手术,对照组行常规开腹手术。对比分析两组手术时间、术中出血量及围手术期并发症等指标。结果:研究组均成功完成电钩法腹腔镜手术,无一例中转开腹。研究组术中失血量、术后腹腔引流量、术后肠道功能恢复时间、术后切口疼痛、住院时间、住院费用均优于对照组(P<0.05);两组手术时间、术中淋巴结清扫情况、吻合口漏、尿潴留、腹腔感染、切口感染差异无统计学意义(P>0.05)。结论:电钩法腹腔镜结直肠肿瘤手术是安全、可行的,微创效果好,不但可节约医疗资源,同时明显降低了手术费用,在经济条件困难的患者或无超声刀的医院,尤其基层医院值得开展推广。     

腹腔镜结肠镜诊治直肠癌合并结直肠息肉22例分析

目的:探讨直肠癌合并结直肠息肉的发生率及腹腔镜结合结肠镜处理直肠癌合并结直肠息肉的方法。方法:回顾分析腹腔镜、结肠镜处理直肠癌合并结直肠息肉22例患者的临床资料。结果:9例直肠癌患者结肠镜检查结直肠息肉检出率为24.10%,显著高于同期结肠镜检查结直肠息肉的总检出率12.19%(P<0.01)。直肠癌患者行腹腔镜直肠癌根治术,术前、术中行结肠镜息肉切除术14例;术前结肠镜下注射亚甲蓝标记或术中结肠镜引导下,腹腔镜行直肠癌根治术的同时行含息肉结肠部分切除术5例;直肠癌合并升结肠息肉恶变行腹腔镜直肠癌根治术同时行右半结肠切除术1例;息肉靠近直肠癌一并行直肠癌根治性切除术2例。结直肠息肉切除率为100%,无并发症发生。22例术后随访0.5~4年,2例死于肿瘤转移,20例存活,无肿瘤或息肉复发。结论:直肠癌患者合并结直肠息肉的发生率较高。腹腔镜直肠癌根治性切除术的术前或术中有必要行结肠镜检查,根据息肉情况选择结肠镜息肉切除或腹腔镜下息肉切除。     

腹膜透析患者行腹腔镜结直肠手术的安全性分析

目的 探讨腹膜透析患者行腹腔镜结直肠手术的安全性。方法 回顾性分析湖南省郴州市第一人民医院2016年6月至2018年12月接受腹腔镜结直肠癌手术的310例患者的临床资料。对其中4例腹膜透析患者因结直肠癌行腹腔镜结直肠手术患者的临床特点进行分析。结果 所有病例均获得安全有效地治疗。手术时间180~240 min,术后住院时间10~15 d,未出现相关并发症。结论 腹膜透析患者行腹腔镜结直肠手术是安全的。今后还需更多地研究来规范腹膜透析患者在行腹腔镜结直肠手术的围手术期管理。     

Reduction of prolonged postoperative hospital stay after laparoscopic surgery for colorectal carcinoma

Background In evaluating the quality of laparoscopic surgery (LS) for colorectal carcinoma, many previous reports have used median or range values to assess the length of postoperative hospital stay and to show the complication and conversion rates separately. However, with this method, it is impossible to assess the proportion of patients who required prolonged postoperative hospital stay because of perioperative morbidities. This study investigated the proportion of patients who benefited from LS as minimally invasive surgery by assessing the percentage of patients who required prolonged postoperative hospital stay because of major perioperative morbidities. Methods A review of 202 patients who underwent LS for colorectal carcinoma at the authors’ hospital between January 2002 and December 2004 was performed. Short-term outcomes were compared among the patients who underwent LS in 2002, 2003, and 2004. Results No significant differences were observed in baseline characteristics among the groups, and all the procedures in this study were completed laparoscopically. There were no significant differences in the operative times and intraoperative blood losses among the groups. Most of the patients resumed liquid intake on postoperative day 1 and solid food on day 3. However, there was a significant difference in the rate of postoperative prolonged hospital stays by year of surgery. In 2004, 97.3% of the patients (72/74) undergoing LS could be discharged to home within 8 days postoperatively. Major complications occurred at a low rate of 1.4% (1/74) in 2004. Regarding the reasons for prolonged postoperative hospital stay, inappropriate judgment of the physician in charge, based primarily on requests from patients without medical necessity, disappeared in 2004. Conclusions When LS is performed properly by specialists who have accumulated sufficient experience in both LS and conventional open surgery for colorectal carcinoma, up to 97% of patients undergoing LS can benefit from minimally invasive surgery.     

腹腔镜和结肠镜双镜联合微创术治疗结直肠良恶性肿瘤的临床疗效观察

目的探讨腹腔镜和结肠镜双镜联合微创术治疗结直肠良恶性肿瘤的临床疗效。方法回顾性分析在我院就诊的良恶性肿瘤140例,根据治疗方法不同分为开腹组(传统开腹术)和双镜组(腹腔镜和结肠镜双镜联合微创术),每组70例。评价两组患者手术时间、术中出血量、术后镇痛药次数、术后肛门排气时间、排便时间、术后引流量、术后引流时间、术后下床活动时间、总住院时间及术后等并发症情况。结果与开腹组相比,双镜组患者手术时间较短,手术出血量和术后引流量较少,术后镇痛次数较少,差异有统计学意义(P0.05);双镜组患者手术后引流时间、肛门排气和排便时间与开腹组相比较短,差异有统计学意义(P0.05)。与开腹组相比,双镜组患者术后下床时间和住院时间较短,差异有统计学意义(P0.05)。双镜组患者术后并发症发生率为2.8%,显著低于开腹组的20.0%,差异有统计学意义(P0.05)。结论腹腔镜与结肠镜的联合微创术具有微创、痛苦小、出血量少、手术时间短、恢复快的优点,除此之外其定位准确、手术成功率高、切除病变完全等优越性是开腹手术不可比拟的,值得进一步的推广应用。     

Laparoscopic colorectal surgery in the irradiated pelvis

BACKGROUND: Heightened interest in minimally invasive surgery and the expanding use of radiation therapy presents surgeons with new challenges. While conventional surgery in the irradiated pelvis represents a significant technical obstacle, indications for laparoscopic colorectal surgery are currently being defined. The purpose of this study is to examine the efficacy of laparoscopic surgery in the irradiated field. METHODS: Forty-two patients underwent laparoscopic colorectal surgery after preoperative radiation therapy, mean dose of 5,644 cGy. All patients were assessed according to intraoperative issues and perioperative events. RESULTS: Eleven patients underwent diverting stoma formation whereas 31 patients underwent resections. The overall conversion rate was 7% (n = 3). Average blood loss was 378 mL. There were no perioperative deaths. Overall morbidity was 19% (n = 8). 78% of patients tolerated clear liquids by postoperative day 2, and 73% tolerated a house diet by postoperative day 4. Average length of stay was 5.5 days. CONCLUSIONS: With proper patient selection and laparoscopic experience, laparoscopic colorectal surgery can be performed in the irradiated pelvis without undue morbidity and mortality.     

Management of obstructive colorectal cancer with endoscopic stenting followed by single-stage surgery: open or laparoscopic resection?

BACKGROUND: About one-third of patients with colorectal carcinoma present with acute colonic obstruction requiring emergency surgery. Current surgical options are intraoperative lavage and resection of the colonic segment involved with primary anastomosis, subtotal colectomy with primary anastomosis, colostomy followed by resection, and resection of the colonic segment involved with end colostomy (Hartmann's procedure) requiring a second operation to reconstruct the colon. These procedures present risks and a poor quality of life. Endoscopic colonic stent insertion can effectively decompress the obstructed colon, allowing bowel preparation and elective resection. METHODS: The authors present their experience managing 31 patients with obstructing colorectal cancer who underwent endoscopic colonic decompression with self-expanding metallic stents. A total of 16 patients were treated with open resection, and 6 underwent a laparoscopic resection. The remaining 9 patients were managed with endoscopic palliation and adjuvant therapy. Of the 31 patients, 17 were treated with postoperative chemotherapy. RESULTS: The mean interval between stenting and surgery was 11 days (range, 1-21 days). There was no intraoperative morbidity. The incidence of postoperative morbidity was 20% for open surgery and 0% for laparoscopic surgery. The mean postoperative hospital stay was 13 days for the open surgery group, and 7 days for the laparoscopic group (p = 0.003). The hospital mortality rate was 3.2%. Follow-up evaluation was completed for 96% of the patients. The minimum follow-up period was 15 months. All the patients in the palliative group died of disease, with a median survival of 3 months. Of the 22 surgically treated patients, 17 (77%) are alive at this writing. CONCLUSION: This initial experience shows that after successful endoscopic stenting of malignant colorectal obstruction, elective surgical resection can be performed safely. The presence of the endoluminal stent does not prevent a laparoscopic approach. The combined endoscopic and laparoscopic procedures are a less invasive alternative to the multistage open operations and offer a faster recovery.     

腹腔镜下结直肠癌肝转移一期手术23例临床疗效

目的探讨腹腔镜下治疗结直肠癌肝转移一期的安全性及有效性。方法回顾分析2011年1月至2013年6月行结直肠癌肝转移手术的43例患者的临床资料,将23例患者同时行腹腔镜切除肝转移灶切除术纳入腹腔镜组,20例患者同时行开放性肝转移灶切除术患者纳入开腹组。采用SPSS 23.0软件进行分析,中位生存时间、生存率及术后并发症比较采用χ2检验;计量资料采用(x珋±s)表示,比较采用独立样本t检验,生存分析采用Kaplain-Meire法计算生存率。P0.05表示差异有统计学意义。结果腹腔镜组患者手术时间及术后腹腔引流管留置时间较开腹组显著减少(P0.05);两组患者术中出血量、术后肛门排气时间及术后住院时间差异无统计学意义(P0.05);两组患者术后生存率相近,无围手术期死亡病例,术后均未见严重术后并发症。结论腹腔镜下结直肠癌肝转移一期联合切除安全可行,具有较好的疗效。     

腹腔镜辅助或手助结直肠癌根治术

目的总结腹腔镜根治术治疗13例结直肠癌的临床经验。方法回顾分析我科2002年11月-2006年4月13例腹腔镜根治术治疗结直肠癌的临床资料。结肠癌10例，Duke’s A期4例，Duke’s B期6例；直肠癌3例，均为Duke’s A期。结果13例结直肠癌根据肿瘤大小分别采取腹腔镜辅助根治术10例，手助腹腔镜根治术3例，均获成功，无中转开腹手术。无死亡病例。随访1—36个月，平均17个月，未见肿瘤复发。结论依据肿瘤大小和部位选择腹腔镜辅助或手助腹腔镜手术治疗结直肠癌，可以保证手术的安全有效性。     

腹腔镜结肠直肠肿瘤切除术的临床作用

目的：探讨腹腔镜手术在结肠直肠肿瘤切除术中的应用和临床效果。方法：利用腹腔镜技术对109例结肠直肠肿瘤病人进行手术，并对手术操作、术后情况以及并发症等进行分析。结果：109例病人中转开腹手术11例，占10．1％。98例采用腹腔镜方法完成手术切除，其中结肠直肠腺瘤3例，结肠直肠癌95例。95例结肠直肠癌行姑息性切除5例，根治性切除90例；术式为Miles手术31例，右半结肠切除27例，乙状结肠切除18例，前切除16例，降结肠切除2例，横结肠切除1例。本组病人术中无其他脏器损伤、大出血、气体栓塞等发生，术后无因出现并发症而行再手术治疗者，无一例死亡。在进行根治性切除并达到术后半年以上的病人中，目前有局部复发1例，肝和肺转移各1例，术后复发转移率为5．7％。目前尚未发现有腹壁切口和穿刺孔转移。结论：腹腔镜结肠直肠肿瘤切除手术创伤小，安全、可行，具有广阔的推广应用前景。     

结直肠疾病的微创治疗体会

目的:探讨腹腔镜手术治疗结直肠疾病的适应证、安全性和可行性.方法:回顾分析2007年1月至2010年8月为226例结直肠疾病患者施行腹腔镜手术的临床资料.结果:222例成功完成腹腔镜手术,4例中转开腹.手术时间平均(172±65) min,术中出血量平均(95±41) ml.无死亡病例.随访186例恶性肿瘤患者平均26...     

经自然腔道取标本手术在结直肠外科手术中的应用进展

随着腔镜技术的进一步发展以及微创理念应用于结直肠外科疾病的诊治中,结直肠相关疾病的诊治发生了翻天覆地的变化。由传统的经腹手术到腹腔镜手术、经自然腔道手术,再到经自然腔道取标本手术(NOSES),结直肠疾病的外科诊治在微创领域取得了巨大成果。NOSES技术是目前结直肠外科在微创领域前沿的手术方式之一,它通过经直肠、阴道取标本来避免了腹壁的辅助取标本切口,从而将结直肠外科手术进一步微创化。NOSES技术集传统腹腔镜手术的优势与现代微创外科的理念于一体,它在确保手术效果的基础上集中体现了微创、加速康复外科、功能外科、"无疤"等理念的特点。本文主要就国内外各中心开展NOSES技术在结直肠外科诊治开展中的相关经验、心得和体会进行综述。