Hayashi K, Munakata Y
Nagano Municipal Hospital, Department of Surgery.
Nihon Rinsho. 1996 May;54(5):1312-21.
Laparoscopic colorectal surgery was less invasive for patients although it was difficult to perform complete resection of colon combined with regional lymph node. The skillful manner of the laparoscopic surgery was required for the surgical team. The laparoscopic equipments, in order to perform curative dissection of mesenterium and intermediate lymph node, such as Ultrasonic-aspiration surgical unit (USU) or Harmonic scalpel laparoscopic coagulation shears (LCS), were useful for safer dissection of D2 regional lymph node. Meticulous manner of grasping forceps and special dissectors was made sufficient lymph node dissection. The reconstruction of extracorporeal anastomotic technique by hand or valtrac (biofragmentable anastomosis ring) were safer manner for anastomosis after resection of the right side colon. Reconstruction by double stapling technique of linear stapler and circular stapler was admired for anastomosis for left side colonic and rectal surgery. We had safely performed locar resection in 3, partial resection with Do dissection in 2, with D1 dissection in 14, with D2 dissection in 21 and right and left hemicolectomy in 1 each.
腹腔镜结直肠癌手术对患者的侵袭性较小，尽管完整切除结肠并清扫区域淋巴结较为困难。手术团队需要熟练掌握腹腔镜手术技巧。为了进行肠系膜和中间淋巴结的根治性清扫，腹腔镜设备，如超声吸引手术装置（USU）或谐波手术刀腹腔镜凝血剪（LCS），有助于更安全地清扫D2区域淋巴结。精细使用抓钳和特殊解剖器可实现充分的淋巴结清扫。右侧结肠切除术后，采用手工或valtrac（生物可降解吻合环）进行体外吻合技术重建是更安全的吻合方式。左侧结肠和直肠手术采用直线吻合器和圆形吻合器的双吻合器技术进行吻合备受推崇。我们成功进行了3例局部切除、2例D0清扫的部分切除、14例D1清扫、21例D2清扫以及各1例左右半结肠切除术。
