论文部分内容阅读
目的探讨如何合理运用手术技巧避免腹腔镜全直肠系膜切除术(laparoscopic total mesenteric excision,LTME)的手术副损伤的发生。方法对我院2005年1月～2008年6月182例LIME治疗低位直肠癌的临床资料进行回顾性分析,就手术过程中的手术入路、肠系膜下血管及降结肠系膜处理、直肠系膜游离等手术技巧进行总结,寻找避免手术副损伤发生的方法。结果182例均顺利完成LIME,无中转开腹。手术时间115～320min,平均150min。术中出血量15～75m1,平均25m1。术中直肠损伤发生率2.7%(5/182),骶前静脉丛损伤发生率2.2%(4/182),阴道损伤发生率1.1%(2/182),精囊、输精管损伤发生率1.1%(2/182),未发生输尿管损伤、前列腺损伤等。13例手术副损伤镜下缝合或压迫止血成功,术后无吻合口漏等并发症发生。术后病理:低分化腺癌56例,中分化腺癌98例,息肉恶变28例。Dukes分期:A期23例,B期67例,C期92例。182例术后随访6～32个月,平均18个月,均未发现吻合口肿瘤复发及远处转移。结论只要熟练地掌握乙状结肠、直肠毗邻结构的镜下解剖,运用合理的手术技巧和规范的操作可以防范LIME手术副损伤的发生。
Objective To explore how to make rational use of surgical techniques to avoid the occurrence of minor injuries in laparoscopic total mesenteric excision (LTME). Methods A retrospective analysis of 182 cases of LIME for rectal cancer treated in our hospital from January 2005 to June 2008 was performed. Surgical approach, surgical treatment of inferior mesenteric vessels, reduction of mesocolon and rectal mesentery were performed Surgical techniques are summarized to find ways to avoid the occurrence of minor injuries in surgery. Results 182 cases were successfully completed LIME, no transit laparotomy. Operation time 115 ~ 320min, an average of 150min. Intraoperative bleeding 15 ~ 75m1, an average of 25m1. The rate of intraoperative rectal injury was 2.7% (5/182), presacral venous plexus injury rate was 2.2% (4/182), vaginal injury rate was 1.1% (2/182), seminal vesicle and vas deferens injury rate was 1.1% 2/182), no ureteral injury, prostate injury and so on. 13 cases of surgical injury under the microscope or suture hemostasis success, no complications such as anastomotic leakage occurred. Postoperative pathology: 56 cases of poorly differentiated adenocarcinoma, 98 cases of moderately differentiated adenocarcinoma, 28 cases of malignant polyps. Dukes staging: A period in 23 cases, B in 67 cases, C in 92 cases. 182 cases were followed up for 6 to 32 months, an average of 18 months, no recurrence of anastomotic tumors and distant metastasis was found. Conclusions As long as the proficiency of the sigmoid colon, microsurgical anatomy of the adjacent structures of the rectum, the use of reasonable surgical techniques and normative operation can prevent the occurrence of secondary LIME injury.