腹腔镜技术在梗阻性左半结肠癌中的应用体会

doi:10.3969/j.issn.1009-976X.2020.04.006

摘要/Abstract

摘要： 目的探讨腹腔镜技术在治疗梗阻性左半结肠癌中的安全性及可行性。方法回顾性分析2018年10月至2019年10月广东省陆丰市人民医院普外科10例行腹腔镜左半结肠癌根治术患者的临床资料。结果 10例患者均全部顺利完成腹腔镜左半结肠癌根治术,无中转开腹。手术中位时间为171（132~230）min,术中中位出血量为60（20~250）mL,10例患者均行一期切除吻合和预防性回肠造口,中位腹部切口长度为8（9~10）cm,中位淋巴结清扫总数17（12~25）个。术后第1天均恢复流质饮食,术后排气中位时间为1（1~3）天,术后拔除引流管时间1（1~2）天,术后住院中位时间为7（6~12）天。结论腹腔镜技术在治疗梗阻性左半结肠癌中是安全可行的,具有一定的临床应用价值。

关键词: 应用价值, 腹腔镜, 梗阻性左半结肠癌

Abstract: Objective To explore the safety and feasibility of laparoscopic technique in the treatment of obstructive left colon cancer. Methods Retrospective analysis of clinical data of 10 patients undergoing laparoscopic radical resection of left colon cancer from October 2018 to October 2019 in the Department of General Surgery,Guangdong Lufeng People's Hospital. Results Ten patients successfully completed laparoscopic radical resection of left colon cancer and did not switch to open surgery. The median surgery time is 171（132~230） min,median blood loss during surgery was 60 （20~250） ml. All 10 patients underwent one-stage resection, anastomosis and preventive ileostomy. The median abdominal incision length is 8 （9~10） cm, and the median lymphadenectomy is 17 （12~25）. The liquid diet was resumed on the first postoperative day, the median time for postoperative flatus was 1 （1~3） days, the duration of postoperative drainage tube removal was 1 （1~2） days, and the median postoperative hospitalization time was 7 （6~12） days. Conclusion Laparoscopy is safe and feasible in the treatment of obstructive left colon cancer, and has certain clinical application value.

Key words: obstructive left colon cancer, application value, laparoscopy

中图分类号:

R735.3+5

张平, 彭晓锋, 林建涛, 王建锐, 陈金欣, 林峻岭. 腹腔镜技术在梗阻性左半结肠癌中的应用体会[J]. 岭南现代临床外科, 2020, 20(04): 435-439.

ZHANG Ping, PENG Xiao-feng, LIN Jian-tao, WANG Jin-rui, CHEN Jin-xin, LIN Jun-ling. Application value of laparoscopy in obstructive left colon cancer[J]. Lingnan Modern Clinics in Surgery, 2020, 20(04): 435-439.

参考文献

[1] Pirlet IA, Slim K, Kwiatkowski F, et al.Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial[J]. Surg Endosc, 2011, 25(6):1814-1821.
[2] Wang Y, Hu H,Wang M, et al.Self-expanding metallic stent as a bridge to surgery versus emergency surgery for acute obstructive colorectal cancer: a retrospective study[J]. Lancet Oncol, 2011, 12(4): 344-352.
[3] Kim JH, Kwon KA, Lee JJ, et al.Surgical failure after colonic stenting as a bridge to surgery[J]. World J Gastroenterol, 2014, 20(33): 11826-11834.
[4] van Hooft JE, Bemelman WA, Oldenburg B, et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial[J]. Lancet Oncol, 2011, 12(4):344-352.
[5] 中华医学会外科学分会腹腔镜与内镜外科学组,中华医学会外科学分会结直肠外科学组, 中国医师协会外科医师分会结直肠外科医师委员会, 等. 腹腔镜结直肠癌根治术操作指南(2018版)[J]. 中华消化外科杂志, 2018, 17(9): 877-885.
[6] Jayne DG, Guillou PJ, Thorpe H, et al.Randomized Trial of Laparoscopic-Assisted Resection of Colorectal Carcinoma: 3-Year Results of the UK MRC CLASICC Trial Group[J]. J Clin Oncol, 2007, 25(21):3061-3068.
[7] van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial[J]. Lancet Oncol, 2013, 14(3):210-218.
[8] Arezzo A, Bini R, Secco GL, et al.The role of stents in the management of colorectal complications: a systematic review[J]. Surg Endosc, 2017, 31(7):2720-2730.
[9] Lee Y, Law W, Chu K, et al.Emergency surgery for obstructing colorectal cancers: A comparison between right-sided and left-sided lesions[J]. J Am Coll Surg, 2001, 192(6):719-725.
[10] Mege D, Manceau G, Bridoux V, et al.Surgical management of obstructive left colon cancer at a national level: Results of a multicentre study of the French Surgical Association in 1500 patients[J]. J Visc Surg, 2019, 156(3): 197-208.
[11] 夏穗生. 论低位结肠梗阻与急诊一期切除吻合术[J]. 实用外科杂志, 1988, 8(1): 1-2.
[12] Dudley HA,Racliffe AG,McGeehan D. Intraoperative irrigation of the colon to permit primary anastomosis[J]. Br J Surg,1980,67(2):80-81.
[13] Otsuka S, Kaneoka, Maeda A, et al.One-Stage Colectomy with Intraoperative Colonic Irrigation for Acute Left-Sided Malignant Colonic Obstruction[J]. World J Surg, 2015, 39(9):2336-2342.
[14] 戴志慧, 杜金林, 王建平,等. 全结肠灌洗后一期切除吻合联合经阑尾置管造口术在左半结肠或直肠癌急诊手术中的应用[J]. 中华胃肠外科杂志, 2015, 18(5): 507-508.
[15] Sasaki K, Kazama S, Sunami E, et al.One-Stage Segmental Colectomy and Primary Anastomosis After Intraoperative Colonic Irrigation and Total Colonoscopy for Patients with Obstruction Due to Left-Sided Colorectal Cancer[J]. Dis Colon Rectum, 2012, 55(1):72-78.
[16] Ansaloni L, Andersson RE, Bazzoli F, et al.Guidelines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society[J]. World J Emerg Surg, 2011, 5:29.
[17] Harrison ME, Anderson MA, Appalaneni V, et al.The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction[J]. Gastrointest Endosc, 2010, 71(4):669-679.
[18] Arezzo A, Passera R, Lo Secco G, et al.Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials[J]. Gastrointest Endosc, 2017, 86(3): 416-426.
[19] Allievi N, Ceresoli M, Fugazzola P, et al.Endoscopic stenting as bridge to surgery versus emergency resection for left-sided malignant colorectal obstruction: an updated meta-analysis[J]. Int J Surg Oncol, 2017,2017: 2863272.
[20] Matsuda A, Miyashita M, Matsumoto S, et al.Comparison of Long-Term Outcomes of Colonic Stent as “Bridge to Surgery” and Emergency Surgery for Malignant Large-Bowel Obstruction: A Meta-Analysis[J]. Ann Surg Oncol, 2015, 22(2):497-504.
[21] Van Hooft JE, van Halsema EE, Vanbiervliet G, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline[J]. Endoscopy, 2014, 46(11): 990-1053.
[22] Maruthachalam K,Lash GE,Shenton BK, et al.Tumour cell dissemination following endoscopic stent insertion[J]. Br J Surg,2007, 94(9): 1151-1154.
[23] Yamashita S, Tanemura M, Sawada G, et al.Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer[J]. Oncol Lett, 2018, 15(1): 400-406.
[24] Sabbagh C, Browet F, Diouf M, et al.Is Stenting as “a Bridge to Surgery”an Oncologically Safe Strategy for the Management of Acute, Left-Sided, Malignant, Colonic Obstruction? A Comparative Study with a Propensity Score Analysis[J]. Ann Surg, 2013, 258(1):107-115.
[25] Kanemitsu K, Sumi Y, Yamashita K, et al.Effectiveness of Laparoscopic Surgery for Obstructive Colorectal Cancer After Tube Decompression[J]. Surg Laparosc Endosc Percutan Tech, 2016, 26(4):343-346.