微创手术在直肠类癌病人中的应用（附13例报告）_医学论文.docVIP

微创手术在直肠类癌病人中的应用（附13例报告）_医学论文 微创手术在直肠类癌病人中的应用（附13例报告）_医学论文 【摘要】目的 探讨微创手术在直肠类癌的可行性。方法 对本组13例直肠类癌分别采用不同的微创手术方式进行治疗；其中3例经肛门局部切除术，2例带蒂的直肠类癌在内镜下进行圈套手术治疗，5例直径gt2cm或侵犯肌层或浆膜层的肿瘤，全麻下行腹腔镜根治性切除术(Dixon手术)，2例位于5～8cm的直肠类癌侵犯肌层的肿瘤行腹腔镜下改良Welch术（其中1例经肛门局部切除术的患者在术中快速病理证实肿瘤侵犯深肌层，而中转行腹腔镜下改良Welch术），1例位于5～8cm的直肠类癌只局限于黏膜的患者在结肠镜下行黏膜切除术，1例肿瘤位于距肛门3~5cm肿瘤在1~2cm大小且经腔内超声内镜检查证实浸润直肠深肌层，并有淋巴结转移的实施腹腔镜下Miles手术。结果 2例分别因肝转移和肺转移仅生存2年以内，有1例经内镜下圈套治疗的病例在第一次手术后7个月发生局部复发，后在腹腔镜下行根治术，至目前仍健康生存。其余病例至今生存，未发生转移和复发迹象。有2例发生肛瘘，后经肛瘘挂线术得以治愈，有1例经腹腔镜下根治性切除术（Dixon手术)术后发生结肠旁疝、肠梗阻，经开腹手术解除梗阻治愈，其余病例未发生其它并发症。结论 对于直肠类癌肿瘤的大小、部位、浸润深度，采用不同的微创手术方式。 【关键词】直肠类癌 微创手术 【Abstract】 Objictive To explore the feasibility of minimally invasive surgery for rectal carcinoid. Methods 13 cases patients of rectal carcinoid tumors were treated with minimally invasive surgical .among these sases, , 3 cases were treated with transanal excision (TE)，2 cases of pedunculated rectal carcinoid with trap in endoscopic surgery,5 cases of diametergt 2cm or infringe upon the muscularis or serosa layers were treated with laparoscopic radical resection surgery (Dixon surgery) in general anesthesia, 2 cases at the 5 ~ 8cm that invasived the muscularis layers were treated with the laparoscopic modified Welch surgery (1 case with TE were pathologically confirmed deep myometrial invasion , and to switch to laparoscopic modified Welch surgery), 1 cases at the 5 ~ 8cm and limited to the colon mucosa were treated with endoscopic mucosal resection(EMR), 1 case of tumor located away from the anus in 3 ~ 5cm ,the size of 1 ~ 2cm and were confirmed to invasive deep muscularis layer by EUS(endoscopic ultrasonography with the lymph node metastasis were treated with laparoscopic Miles surgery. Results 2 cases survival 2-year due to the hepatic metastasis and lung metastasis, respectively, 1 case treated with trap in endoscopic surgery were re-occurred in local after 7 months ,and were treated with laparoscopic radical correction ,which is still survival. So far the survival of