摘要
目的 探讨腹腔镜下结直肠癌手术如何利用解剖间隙避免副损伤.方法 对94例接受腹腔镜手术的结直肠癌患者进行解剖间隙的观察和研究.结果 94例患者均手术顺利,无中转开腹,手术时间为120～300 min,平均173 min;术中失血量6～260 mL,平均78 mL;淋巴结清扫数目8～42枚,平均17.8枚,其中阳性淋巴结数目0～9枚,平均1.91枚.术后排气时间50～120 h,平均74 h.所有标本切缘均阴性.术后随访观察1～12个月,无一例出现输尿管、骶前神经损伤（排尿和性功能障碍）,无腹腔、骶前大出血等副损伤发生.结论 腹腔镜下结直肠癌手术避免副损伤的方法是找到合理的手术入路和解剖间隙,进入正确的外科平面,保持肾前筋膜和骶前间隙的完整性,直视下充分暴露解剖,谨慎下刀,才能有效地避免副损伤.
Objective To avoid the side injuries with anatomical space in laparoscopic colorectal cancer surgery.Methods Anatomical space was observed and studied in 94 patients undergoing laparoscopic colorectal cancer surgery.Results All patients underwent successful operation and no patients were converted to open surgery. The average operative time was 173 minutes（range, 120 to 300 minutes） and average intraoperative blood loss was 78 mL （range,6 to 260 mL）.The mean number of lymph nodes dissected was 17.8（range,8 to 42）.Among them, the mean number of positive lymph nodes was 1.91 （range,0 to 9）.The average time to postoperative flatus was 74 hours （range ,50 to 120 hours）. Cut edge is negative in all specimens. After 1 to 12 months of follow-up, no patients had ureteral and presacral nerve injury （urinary and sexual dysfunction）,abdominal and presacral bleeding and other side injuries. Conclusion The way of avoiding side injuries in laparoscopic colorectal cancer surgery is to find a reasonable surgery approach and anatomical space.The side injuries can be effectively avoided by entering proper surgical surface, keeping intact prerenal and presacral spaces, dissecting under direct vision and cutting carefully.
出处
《实用临床医学（江西）》
CAS
2013年第9期51-53,共3页
Practical Clinical Medicine
关键词
腹腔镜
结直肠癌
解剖间隙
副损伤
laparoscopy
colorectal cancer
anatomical space
side injury
