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单切口腹腔镜结直肠手术的初步经验

Preliminary clinical experience of single incision laparoscopic colorectal surgery

摘要:

目的 探讨单切口腹腔镜结直肠手术初步临床应用经验.方法 回顾性分析2010年1月至2015年9月104例于中国医科大学附属盛京医院第二普通外科接受单切口腹腔镜结直肠手术患者的临床资料.男性62例,女性42例,年龄21 ~ 87岁,平均年龄(61±12)岁.恶性肿瘤85例,良性疾病19例.全部手术均由同一手术团队以常规腹腔镜器械完成.对经腹直肠癌切除术、腹会阴联合直肠癌切除术、根治性右半结肠切除术、根治性乙状结肠切除术4种超过5例的术式进行分析.结果 5例(4.8%)患者中转传统多孔腹腔镜手术或开腹手术,其余99例均成功完成单切口腹腔镜结直肠手术.经腹直肠癌切除术35例,平均手术时间(191±57) min,平均出血量(112±72) ml,平均清扫淋巴结(14.6±1.1)枚.腹会阴联合直肠癌切除术9例,平均手术时间(226±54) min,平均出血量(194±95) ml,平均清扫淋巴结(14.1±1.5)枚.根治性右半结肠切除术16例,平均手术时间(222±62) min,平均出血量(142±68) ml,平均清扫淋巴结(15.4±2.4)枚.根治性乙状结肠切除术14例,平均手术时间(159±32) min,平均出血量(94±33)ml,平均清扫淋巴结(13.9±1.5)个.术中并发症发生率为2.7% (2/74),术后并发症发生率为8.1% (6/74).结论 通过严格的患者选择,由经验丰富的腹腔镜外科医师实施单切口腹腔镜结直肠手术是安全的.

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abstracts:

Objective To discuss the preliminary experience of single incision laparoscopic colorectal surgery.Methods The clinical data and surgical outcomes of 104 selected patients who underwent single incision laparoscopic colorectal surgery in the 2nd Department of General Surgery,Shenging Hospital of China Medical University from January 2010 to September 2015 were retrospectively analyzed.There were 62 male and 42 female patients,aging from 21 to 87 years with a mean of (61 ± 12) years.Eighty-five patients were diagnosed with malignancy while the rest 19 cases were benign diseases.All the procedures were performed by the same surgeon using the rigid laparoscopic instruments.Surgical and oncological outcomes were analyzed in 4 kinds of procedures which are over 5 cases respectively,including low anterior resection,abdominoperineal resection,radical right colon resection and radical sigmoidectomy.Results Single incision laparoscopic colorectal surgery was performed in 104 selected patients and was successfully managed in 99 cases with a total conversion rate of 4.8%.Radical procedures for malignancy in cases with the number of patients more than 5 were performed for 74 cases.For low anterior resection,35 cases with an average surgical time of (191±57) minutes,average estimated blood loss of (117 ±72)ml and average number of harvested lymph nodes of 14.6±1.1.For abdominoperineal resection,9 cases with an average surgical time of (226 ± 54) minutes,average estimated blood loss of (194 ± 95) ml and average number of harvested lymph nodes of 14.1 ± 1.5.For radical right colon resection,16 cases with an average surgical time of (222 ± 62) minutes,average estimated blood loss of (142 ± 68) ml and average number of harvested lymph nodes of 15.4 ± 2.4.For radical sigmoidectomy,14 cases with an average surgical time of (159 ± 32) minutes,average estimated blood loss of (94 ± 33) ml and average number of harvested lymph nodes of 13.9 ± 1.5.The overall intraoperative complication rate was 2.7% (2 cases) and postoperative complication rate was 8.1% (6 cases) in these 74 cases.Conclusion Single incision laparoscopic colorectal surgery is safe and feasible with acceptable surgical outcomes and cosmetic benefits in the hands of skilled laparoscopic surgeon in well-selected patients.

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作者: 吴硕东 [1] 韩金岩 [1]
第一作者: 吴硕东
期刊: 《中华外科杂志》2016年54卷6期 429-433页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2016.06.008
发布时间: 2016-07-05
基金项目:
辽宁省省直医院改革重点临床科室诊疗能力建设项目 Constructive Projects in the Capacity of Diagnosis and Treatment in Reformational Major Clinical Departments of Hospitals Directly under the Province of Liaoning
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