腹腔镜左半结肠癌根治手术的技巧与短期疗效.DOCVIP

临床医学论文-腹腔镜左半结肠癌根治手术的技巧与短期疗效 ????????? 作者：郑民华 马君俊 陆爱国 宗雅萍 胡伟国 王明亮 李健文 毛志海 董峰 臧潞 【摘要】? 目的 探讨腹腔镜左半结肠癌根治术的手术操作技巧与短期疗效。方法 回顾性分析2001年8月至2006年7月上海微创外科临床医学中心28例行腹腔镜左半结肠癌根治术患者资料，并探讨其手术操作技巧、术后恢复情况及肿瘤根治性效果。结果 Ⅰ期病例1例，Ⅱ期17例，Ⅲ期10例。所有病例无术中严重并发症和手术死亡，3例(10.7%)中转开腹。手术时间为155 min，术中平均出血量为100 ml，排气时间、进食流质、半流质时间和住院天数分别为3、4、5.5、12 d。清扫淋巴结数为11枚，其中结肠上、旁淋巴结4枚，系膜间淋巴结4枚，血管根部淋巴结2枚，手术切除标本长度为14 cm。术后吻合口漏2例，肠梗阻1例，肺部感染1例。所有患者均获随访6～55个月，中位随访时间17.5个月。2例发生肝转移，短期累计生存率为92.4%。结论 腹腔镜左半结肠切除术治疗左半结肠癌是安全有效的，符合肿瘤根治原则。 【关键词】? 腹腔镜； 左半结肠切除术； 结肠肿瘤 ??? 【Abstract】? Objective? To assess the surgical skills and outcomes of laparoscopeassisted left hemicolectomy (LLH) for colon carcinoma. Methods? The technique of operation, status of recovery, complications, oncological clearance and of shortterm followup results were studied on 28 patients who underwent laparoscopeassisted left hemicolectomy for colon cancer from August 2001 to July 2006. Results? A total of 15 males and 13 females at age of 3085 years (mean 58 years) were enrolled in the study. Of all, there was one case at stage I, 17 at stage II and 10 at stage III. No severe complications and death occurred during the operation. Three cases (10.7%) were converted to open surgery. The mean operation time was 155 minutes (70240 minutes) and the blood loss 100 ml (0500 ml). The mean time for passage of flatus，time to liquid diet, semiliquid diet and hospital stay were 3 days (27 days), 4 days (38 days), 5.5 days (49 days) and 12 days (854 days) respectively. There were 11 lymph nodes (420) including 4 (29) from colon and side colon, 4 (113) from intermesentery and 2 (17) from root site of blood vessel. The length of specimen removed was 14 cm (729 cm). Complications were observed in four cases，with two cases (7.1%) of anastmosis leakage, one (3.6%) of pulmonary infection and one (3.6%) of ileus．All the cases were followed up for 655 months (average 17.5 months), as showed the cumulative survival rate of 92.4%. Conclusions? Laparoscopeassisted