Račkauskas Rokas, Mikalauskas Saulius, Petrulionis Marius, Poškus Tomas, Jotautas Valdemaras, Stanaitis Juozas, Poškus Eligijus, Strupas Kęstutis
Centre of Abdominal Surgery, Vilnius University, Vilnius, Lithuania.
Center of Hepatology and Gastroenterology, Vilnius University, Vilnius, Lithuania.
Wideochir Inne Tech Maloinwazyjne. 2017 Jun;12(2):120-124. doi: 10.5114/wiitm.2017.68138. Epub 2017 May 30.
Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most frequent cause of cancer-related death in the world. CRC screening programs have been widely introduced worldwide, allowing for early detection and removal of precancerous lesions and avoiding major surgical intervention. However, not all polyps are suitable for conventional and advanced colonoscopic polypectomy. Thus, laparoscopically assisted colonoscopic polypectomy (LACP) was introduced to clinical practice as a method of choice for these polyps and adenomas.
To overlook our experience in laparoscopically assisted colonoscopic polypectomies and evaluate effectiveness and quality of the procedure.
A retrospective analysis of a prospectively maintained database was performed. using the Vilnius University Hospital Santariskiu Klinikos patient database for the period from 2010 to 2016, resulting in 21 cases in which LACP was performed. All procedures were performed using combined laparoscopy and videocolonoscopy techniques. Morphology of adenomas was classified according to the Paris classification during the procedure. Creation of the database was approved by the Lithuanian Bioethics committee.
Twenty-two adenomas were removed from 21 patients, aged 65.33 ±8.9. There was no difference between male and female age, but occurrence of adenomas in females was 2-fold higher. The majority of removed lesions were localized in the cecum and mean size was 27.2 ±11.1 mm. The morphology of adenomas was distributed equally between 0-Is, 0-Ip, and 0-IIa, except one, which belonged to 0-III. Histological analysis revealed that tubulovillous adenoma occurrence was 1.4 times higher than tubulous adenoma. There was only one postoperative complication - bleeding from the adenoma resection site, which was managed by conservative means. One patient developed G2 adenocarcinoma at the polyp resection site and was referred for radical surgery.
The LACP is a safe procedure with minimal risk to the elderly patient. Patient follow-up is essential for detection of recurrence.
结直肠癌（CRC）是全球第三大常见癌症，也是全球第四大癌症相关死亡原因。CRC筛查项目已在全球广泛推行，可实现癌前病变的早期检测与切除，避免重大手术干预。然而，并非所有息肉都适合传统及先进的结肠镜息肉切除术。因此，腹腔镜辅助结肠镜息肉切除术（LACP）作为这些息肉和腺瘤的一种首选方法被引入临床实践。
回顾我们在腹腔镜辅助结肠镜息肉切除术中的经验，并评估该手术的有效性和质量。
对一个前瞻性维护的数据库进行回顾性分析。使用维尔纽斯大学医院桑塔里斯基乌临床医院2010年至2016年期间的患者数据库，共有21例患者接受了LACP手术。所有手术均采用腹腔镜和视频结肠镜联合技术。术中根据巴黎分类法对腺瘤形态进行分类。数据库的创建获得了立陶宛生物伦理委员会的批准。
从21例患者中切除了22个腺瘤，患者年龄为65.33±8.9岁。男性和女性年龄无差异，但女性腺瘤发生率高出2倍。大多数切除的病变位于盲肠，平均大小为27.2±11.1毫米。腺瘤形态在0-Is、0-Ip和0-IIa之间分布均匀，只有一个属于0-III。组织学分析显示，管状绒毛状腺瘤的发生率比管状腺瘤高1.4倍。术后仅出现1例并发症——腺瘤切除部位出血，通过保守方法处理。1例患者在息肉切除部位发生G2腺癌，被转诊进行根治性手术。
LACP是一种安全的手术，对老年患者风险极小。患者随访对于复发检测至关重要。
