腹腔镜结肠次全切除术治疗结肠结核2例

目的探讨应用腹腔镜、纤维结肠镜术中判断结肠的病变范围，腹腔镜完成结肠次全切除术的可行性。方法全麻，仰卧位，脐部上方、下方、左下腹、右下腹分别置入10 mm trocar，右上腹置入5 mm trocar。右半结肠切除时腹腔镜置放于下腹部，左半结肠切除时腔镜置于右下腹部。术中经右结肠断端置人纤维结肠镜配合定位。自回盲部始游离结肠至乙状结肠。扩大左下腹部切口至4cm，腹腔外回肠、乙状结肠吻合。结果2例结肠结核腹腔镜下可以明确观察到结肠、小肠壁的增厚、变硬等改变，术中纤维结肠镜可见结肠黏膜的假性息肉及溃疡等病理改变已波及到降结肠及部分乙状结肠。手术时间分别170、190min。术中出血分别150、200ml。2例术后病理证实为肠结核。切除结肠及回肠术后近期无并发症发生。术后近期大便每天5～6次，术后5、6个月随访大便每天1～2次。体重分别增加2．5、4kg。结论腹腔镜术中配合纤维结肠镜可以准确判断结肠的病变范围，腹腔镜下结肠次全切除术安全可行。

Laparoscopic subtotal colectomy for tuberculosis of colon: Report of 2 cases

Objective To explore the feasibility of laparoscopic subtotal colectomy on the basis of lesion identification with the combined use of laparoscopy and fibrocolonoscopy.Methods The operation was carried out under general anesthesia.The patients were maintained at a supine position.Four 10 mm trocars were introduced at the upper and lower borders of the umbilicus,and the left and right lower quadrants of the abdomen,respectively,and a 5 mm trocar was introduced at the right upper quadrant of the abdomen.The laparoscope was placed at the hypogastrium when performing right hemicolectomy,and at the left lower abdomen when left hemicolectomy.During the operation,a fibrocolonoscope was inserted by way of the severed end of the right colon for lesion identification.The colon was disconnected from the cecum to the sigmoid colon.Then the incision at the left lower abdomen was extended to 4 cm in length,and an extracorporeal ileosigmoidostomy was conducted. Results Pathologic changes of thickening and hardening intestinal walls were clearly observed under laparoscope.Fibrocolonoscopic examinations revealed that the false polyps and ulcers on the colonic mucosa had involved the descending colon and the part of the sigmoid colon.The operation time was 170 min and 190 min,respectively,and the intraoperative blood loss was 150 ml and 200 ml,respectively.Pathological examinations after the operation verified the presence of intestinal tuberculosis.No short-term complications occurred after the operation.The frequency of defecation was 5~6 times daily at short-term postoperative period and 1~2 times daily at 5~6 months after the operation.The patients' body weight increased by 2.5 kg and 4 kg,respectively. Conclusions Combined use of laparoscopy and fibrocolonoscopy can accurately evaluate the affected extent of the lesion.Laparoscopic subtotal colectomy is safe and feasible.