腹腔镜下激光根治性切除直肠癌的初步探讨(附9例报告)
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摘要
目的探讨在腹腔镜下利用接触性激光根治性切除直肠癌的手术方法。方法 2017年2月至2018年3月,直肠癌患者9例,采用腹腔镜辅助下接触性激光直肠癌根治术治疗,激光功率10 W。术后6～19个月随访,记录患者手术时间、出血量、淋巴结清扫数目、盆腔引流量、肠功能恢复时间,观察治疗疗效。结果 9例患者手术顺利,手术时间80～150 min,平均(108.9±24.3) min;术中出血10～30 ml,平均(20±6.1) ml;术后2～4d排气,平均排气时间(3.11±0.8) d;手术清扫淋巴结数13～50枚,平均(24.2±14.9)枚。术后恢复正常,无切口红肿等感染征象,术后3～5 d拔除引流管,7 d拆线,术后7～9 d出院,随访6～19个月无复发,实验室检查和影像学检查无异常。结论在腹腔镜辅助下,可利用接触性激光刀进行直肠癌根治手术,创伤小、恢复快、出血少,是一种安全有效的新型微创手术方法,值得推广应用。
Objective To investigate a radical operation using contacted laser operative system for rectal cancer patients.Methods The data of 9 patients given laparoscopic radical resection with contacted laser was collected from Feb.2017 to Mar.2018,laser power is 10 W.Post operative follow-up 6 to 19 months,the operative time, blood loss, lymph node harvest, operative complican tion and therapeutic effect were recorded.Results All the operations were done successfully and smoothly.Operation time is 80-150( 108.9 ±24.3) min.The blood loss during operation was 10-30(20 ±6.1) ml, and intestinal restorative time 2-4(3.11 ±0.8) d.The lymph node harvest was 13-50(24.2±14.9).There was no infective complication or other serious surgical complications.All the patients were followed up for 6-19 months,no recurrence sign or plasma tumor marker was found, and no imaging abnormality appeared.Conclusions Featuring mild hurt, fast restoration and little blood loss, it is a reliable minitrauma operation to treat rectal cancer patients with contacted laser and should be promoted for wide application.
Objective To investigate a radical operation using contacted laser operative system for rectal cancer patients.Methods The data of 9 patients given laparoscopic radical resection with contacted laser was collected from Feb.2017 to Mar.2018,laser power is 10 W.Post operative follow-up 6 to 19 months,the operative time, blood loss, lymph node harvest, operative complican tion and therapeutic effect were recorded.Results All the operations were done successfully and smoothly.Operation time is 80-150( 108.9 ±24.3) min.The blood loss during operation was 10-30(20 ±6.1) ml, and intestinal restorative time 2-4(3.11 ±0.8) d.The lymph node harvest was 13-50(24.2±14.9).There was no infective complication or other serious surgical complications.All the patients were followed up for 6-19 months,no recurrence sign or plasma tumor marker was found, and no imaging abnormality appeared.Conclusions Featuring mild hurt, fast restoration and little blood loss, it is a reliable minitrauma operation to treat rectal cancer patients with contacted laser and should be promoted for wide application.
引文
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[9]丁元升,田相安,孙钦立,等.双源螺旋CT血管成像在保留左结肠动脉的3D腹腔镜下直肠瘤根治术中的应用研究[J].影像研究与医学应用,2018,2:59-61
[10] Goh N,Fong SS,How KY,et al. Apical lymph node dissection of the inferior mesenteric artery[J]. Colorectal Dis,2016.18:206-209.
[11] Moszkowicz D,Alsaid B,Bessede T,et al. Where does pelvic nerve injury occur during rectal surgery for cancer[J]. Colorectal Dis, 2011,26:13.
[12]王春喜,卢灿荣,刘庆,等.腹腔镜手术治疗高龄老年直肠癌效果观察[J].人民军医,2017,60:567-570.
[2]吴孟超,吴在德,黄家驷.外科学[M].北京:人民卫生出版社,2008.1644-1645.
[3] Sekimoto M,Takemasa I,Mizushima T,et al. Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery[J]. Surg Endosc,2011,25:861-866.
[4]杜燕夫,渠浩,李敏哲,等.腹腔镜直肠癌切除肠系膜血管裸化及左结肠动脉保留术[J].中华普外科手术学杂志(电子版),2014, 8:138.
[5]臧潞,马君俊,郑民华.直肠癌根治术中保留左结肠动脉对吻合口瘘及手术时间的影响[J].中华胃肠外科杂志,2016,19:386-387.
[6]郑玉贵,徐红,洪泽仁.Nd:YAG激光治疗直肠癌[J].激光杂志,1999,20:72-73.
[7]顾瑛.临床技术操作规范激光医学分册[M].北京:人民军医出版社,2010.2-29.
[8] Yasuda K,Kawai K,Ishihara S,et al. Level of arterial ligation in sigmoid colon and rectal cancer surgery[J]. World J Surg Onc,2016,14:99.
[9]丁元升,田相安,孙钦立,等.双源螺旋CT血管成像在保留左结肠动脉的3D腹腔镜下直肠瘤根治术中的应用研究[J].影像研究与医学应用,2018,2:59-61
[10] Goh N,Fong SS,How KY,et al. Apical lymph node dissection of the inferior mesenteric artery[J]. Colorectal Dis,2016.18:206-209.
[11] Moszkowicz D,Alsaid B,Bessede T,et al. Where does pelvic nerve injury occur during rectal surgery for cancer[J]. Colorectal Dis, 2011,26:13.
[12]王春喜,卢灿荣,刘庆,等.腹腔镜手术治疗高龄老年直肠癌效果观察[J].人民军医,2017,60:567-570.