Walfisch S, Twena M, Avinoah E, Charuzi I
Dept. of Surgery C, Soroka Medical Center, Beer Sheba.
Harefuah. 1994 Jan 16;126(2):57-9, 112.
After gaining experience in laparoscopic cholecystectomy, laparoscopic appendectomy and other laparoscopic procedures, we decided to perform laparoscopic-assisted colectomy. During July 1992 to February 1993 we performed 14 such procedures. Ages ranged from 46-83 years (mean, 68). In all cases the indication for surgery was neoplasm of the colon. 8 of the tumors were located in the right colon and 6 in the sigmoid. Procedures performed were laparoscopic-assisted right hemicolectomy with a biofragmentable anastomotic ring or laparoscopic-assisted sigmoidectomy with end-to-end anastomosis. In 1 operation we combined laparoscopic cholecystectomy with laparoscopic right hemicolectomy. Operation time varied from 90-130 min (mean, 100 min). In our opinion the procedure is as radical as standard laparotomy with the number of lymph nodes per specimen ranging from 4-10 (mean, 7); the surgical margins were free of tumor in all cases. There was less pain in the postoperative period than with the standard procedure and the average time from operation to discharge was 7 days (range, 5-9). Complications included 1 fatality due to postoperative myocardial infarction, and 1 case of duodenal perforation which was sutured during the operation. We conclude that laparoscopic-assisted right hemicolectomy and laparoscopic sigmoidectomy are feasible for carcinoma, and that recovery is quicker and with less pain. However, we need a larger series and long-term follow-up to conclude whether the laparoscopic assisted technic is an adequate operation in cases of cancer.
在积累了腹腔镜胆囊切除术、腹腔镜阑尾切除术及其他腹腔镜手术的经验后，我们决定开展腹腔镜辅助结肠切除术。1992年7月至1993年2月期间，我们实施了14例此类手术。患者年龄在46至83岁之间（平均68岁）。所有病例的手术指征均为结肠肿瘤。其中8例肿瘤位于右半结肠，6例位于乙状结肠。实施的手术包括使用生物可降解吻合环的腹腔镜辅助右半结肠切除术或端端吻合的腹腔镜辅助乙状结肠切除术。有1例手术中我们将腹腔镜胆囊切除术与腹腔镜右半结肠切除术联合进行。手术时间从90至130分钟不等（平均100分钟）。我们认为该手术与标准开腹手术一样彻底，每个标本的淋巴结数量为4至10个（平均7个）；所有病例的手术切缘均无肿瘤。术后疼痛程度低于标准手术，平均手术至出院时间为7天（范围5至9天）。并发症包括1例术后心肌梗死死亡病例，以及1例术中缝合的十二指肠穿孔病例。我们得出结论，腹腔镜辅助右半结肠切除术和腹腔镜乙状结肠切除术对于结肠癌是可行的，且恢复更快、疼痛更少。然而，我们需要更大规模的病例系列和长期随访来确定腹腔镜辅助技术在癌症病例中是否为一种充分的手术方式。
