Dulskas Audrius, Samalavicius Narimantas Evaldas, Gupta Rakesh Kumar, Zabulis Vaidotas
Department of Abdominal and General Surgery and Oncology, Center of Surgical Oncology, Vilnius, Lithuania.
Center of Surgical Oncology, National Cancer Institute, Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius, Lithuania.
Wideochir Inne Tech Maloinwazyjne. 2015 Apr;10(1):73-8. doi: 10.5114/wiitm.2015.49752. Epub 2015 Mar 13.
Because of their difficult location or size, some polyps are impossible to remove with a flexible colonoscope and must be surgically removed. Laparoscopy is a great alternative.
To assess outcomes of a laparoscopic approach for the management of difficult colorectal polyps.
From 2006 to 2014, patients with polyps that could not be treated by endoscopy were included. Demographic data, histology of the biopsy, type of surgery, length of postoperative stay, complications and final pathology were reviewed prospectively.
Forty-two patients with a mean age of 64.9 ±8.4 underwent laparoscopic polypectomy. Laparoscopic mobilization of the colonic segment and colotomy with removal of the polyp was performed for 12 (28.6%) polyps. Laparoscopic segmental bowel resection was performed in 30 (71.4%) cases: anterior rectal resection with partial total mesorectal excision in 12 (28.6%), left hemicolectomy in 7 (16.6%), sigmoid resection in 6 (14.3%), ileocecal resection in 2 (4.76%), resection of transverse colon in 2 (4.76%) and sigmoid resection with transanal retrieval of specimen in 1 (2.38%). Mean postoperative hospital stay was 5.9 ±2.6 days. There were 4 complications (9.5%). All patients recovered after conservative treatment. Mean polyp size was 3.6 ±2.2 cm. Final pathology revealed polyps (n = 2), tubular adenoma (n = 6), tubulovillous adenoma (n = 20), carcinoma in situ (n = 10) and invasive cancer (n = 4). Two of these patients underwent laparoscopic left hemicolectomies 14 and 10 days after laparoscopic colotomy and polypectomy.
For the management of endoscopically unresectable polyps, laparoscopic polypectomy is currently the technique of choice.
由于某些息肉位置特殊或体积较大，无法通过柔性结肠镜切除，必须进行手术切除。腹腔镜检查是一种很好的替代方法。
评估腹腔镜手术治疗困难结直肠息肉的效果。
纳入2006年至2014年无法通过内镜治疗的息肉患者。前瞻性回顾患者的人口统计学数据、活检组织学、手术类型、术后住院时间、并发症及最终病理结果。
42例平均年龄为64.9±8.4岁的患者接受了腹腔镜息肉切除术。12例（28.6%）息肉采用腹腔镜游离结肠段并切开结肠切除息肉；30例（71.4%）行腹腔镜节段性肠切除术：12例（28.6%）行直肠前切除术并部分全直肠系膜切除，7例（16.6%）行左半结肠切除术，6例（14.3%）行乙状结肠切除术，2例（4.76%）行回盲部切除术，2例（4.76%）行横结肠切除术，1例（2.38%）行乙状结肠切除术并经肛门取出标本。术后平均住院时间为5.9±2.6天。有4例并发症（9.5%）。所有患者经保守治疗后康复。息肉平均大小为3.6±2.2cm。最终病理显示息肉2例、管状腺瘤6例、绒毛状管状腺瘤20例、原位癌10例和浸润癌4例。其中2例患者在腹腔镜结肠切开息肉切除术后14天和10天接受了腹腔镜左半结肠切除术。
对于内镜无法切除的息肉，腹腔镜息肉切除术是目前的首选技术。
