Lorenz E P, Konradt J, Ehren G, Ernst F
Chirurgische Abteilung, Städtisches Krankenhaus Zehlendorf, örtl. Bereich Behring, Berlin.
Zentralbl Chir. 1998;123(6):746-51.
Laparoscopic techniques in surgical treatment of colorectal cancer are performed present in prospective trials. Operation times are clearly decreasing with growing surgical experience and oncological criteria concerning resection margins and lymphatic dissection are comparable with open surgery. Indications for laparoscopic rectal resections are the endoscopic non removable adenoma and cancer of the upper and lower rectum endosonographic up to maximum uT3-stage. All laparoscopic resections are performed under conventional oncological criteria: after exploration of the abdominal cavity and laparoscopic ultrasound of the liver we perform the ligature of the inferior mesenteric vein and artery. Dissection and resection of the mesorectum is done by the Harmonic Scalpel. The rectum is taken out by mini laparotomy and anastomosis is done by transanal stapler.
腹腔镜技术在结直肠癌手术治疗中的应用目前已在前瞻性试验中开展。随着手术经验的增加，手术时间明显缩短，且关于切缘和淋巴结清扫的肿瘤学标准与开放手术相当。腹腔镜直肠切除术的适应证为内镜下不可切除的腺瘤以及上、下直肠的癌，经腔内超声检查肿瘤最大分期为uT3期。所有腹腔镜手术均按照传统肿瘤学标准进行：在探查腹腔和对肝脏进行腹腔镜超声检查后，结扎肠系膜下静脉和动脉。使用超声刀进行直肠系膜的分离和切除。通过小切口剖腹术取出直肠，并使用经肛门吻合器进行吻合。
