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目的探讨腹腔镜下同时行右半结肠癌与直肠癌手术治疗的可行性。方法对13例右半结肠癌与直肠癌并存的患者,采用腹腔镜下同时手术。13例患者中3例进行腹腔镜下全大肠切除,回肠J型储袋肛管吻合术,10例行Ⅰ期行右半结肠根治术联合直肠癌根治术(CME)。CME原则均行D3手术,直肠手术遵循全直肠系膜切除术原则。行直肠前切除9例,经腹会阴联合直肠癌根治术1例。中转开腹1例。结果术前肠镜探查符合率69.23%(9/13),腹腔镜手术探查发现4例。12例Ⅰ期愈合,无切口感染,无吻合口瘘,无肠黏连肠梗阻。手术后中位进流食时间1~3天,进食固体食物的时间6~9天,手术后平均住院时间(8.7±0.8)天。9例完成3年随访,7例无瘤存活。结论对于同时伴有右半结肠癌和直肠癌的患者,腹腔镜是一种比较好的探查和手术根治方式,Ⅰ期切除安全、有效。
Objective To investigate the feasibility of simultaneous laparoscopic surgery of right colon cancer and rectal cancer. Methods Thirteen patients with right colon cancer and rectal cancer were treated with simultaneous laparoscopic surgery. Three of the 13 patients underwent laparoscopic total colorectal resection, ileum J-type reservoir anal canal anastomosis, and 10 patients underwent right-angiocolumn radical mastectomy combined with rectal cancer radical mastectomy (CME). CME principles are undergone D3 surgery, rectal surgery following the principle of total mesorectal excision. 9 cases underwent rectal anterior resection and 1 case underwent radical perineal and rectal cancer radical mastectomy. 1 case of laparotomy. Results The coincidence rate of preoperative colonoscopy was 69.23% (9/13). Four cases were found by laparoscopic exploration. 12 cases of primary healing, no incision infection, no anastomotic leakage, no intestinal adhesion intestinal obstruction. After surgery, the median time for entering the stream was 1 to 3 days, the time for eating solid food was 6 to 9 days, and the average length of stay after surgery was (8.7 ± 0.8) days. 9 cases completed 3 years follow-up, 7 cases survived without tumor. Conclusion For patients with right colon cancer and rectal cancer at the same time, laparoscopy is a good method of exploration and radical surgery, Ⅰ resection is safe and effective.