Croce E, Azzola M, Russo R, Golia M, Olmi S
1st Department of General and Thoracic Surgery, Fatebenefratelli Hospital, Milan, Italy.
JSLS. 1997 Jul-Sep;1(3):217-24.
The aim of this study is to review our experience performing laparoscopic colon surgery and to present the operative technique as used and standardized by us.
From April 1992 to December 1996, 158 consecutive patients underwent laparoscopic colon surgery. There were 92 females and 66 males, whose average age was 66.7 years (range 31-92); 134 patients (84.9%) were operated on for carcinoma, and the remaining 24 (14.1%) or benign disease.
There were 117 procedures completed laparoscopically out of 158 patients (74%); 103 colon resections (18 for benign disease and 95 for malignant disease), 7 Hartmann procedures, 3 for reversal of Hartmann's procedures, 1 rectopexy, and 3 ileotrasversostomies. Conversions were required in 41 out of 158 cases (25.9%); 19 of these cases, however, were converted to a laparoscopic-facilitated procedure. The most common causes for conversion were the presence of bulky tumors and/or tumors that contaminated adjacent structures (16/158), adhesions due to previous operations (8/158) or patient obesity (5/158). There were 31 complications (19.6%), 9 of which required re-operation. There was only one recurrence (0.9%) that manifested 15 months after the procedure, at both trocar and drainage sites, and with peritoneal carcinomatosis. This occurred in a patient with rectal neoplasia who suffered a perforation of the rectum during dissection, with bowel spillage. The average number of lymph nodes harvested in resected specimens was 12.8 (range 1-41), whereas the mean distance of the tumor from the proximal margin of resection was 11.5 cm (range 5-35), and from the distal margin 7.5 cm (range 1-25). The average operative time was 165 minutes (range 40-360), and the mean hospital stay was 9.2 days (range 6-40). There were three mortalities out of 158 patients (1.9%).
Laparoscopic colon resection for malignant lesions, performed with the highest respect for oncologic principles, has demonstrated that it is difficult to develop a barrier to wall and intraluminal recurrence. Recurrence, in our opinion, is caused by improper surgical technique. Therefore, neoplastic colon laparoscopic surgery must be the prerogative of selected and specialized centers.
本研究旨在回顾我们进行腹腔镜结肠手术的经验，并介绍我们所采用并标准化的手术技术。
1992年4月至1996年12月，158例患者连续接受了腹腔镜结肠手术。其中女性92例，男性66例，平均年龄66.7岁（范围31 - 92岁）；134例患者（84.9%）因癌接受手术，其余24例（14.1%）为良性疾病。
158例患者中有117例手术通过腹腔镜完成（74%）；103例结肠切除术（18例为良性疾病，95例为恶性疾病），7例Hartmann手术，3例Hartmann手术回纳术，1例直肠固定术，3例回肠横结肠造口术。158例中有41例（25.9%）需要中转手术；然而，其中19例中转至腹腔镜辅助手术。中转最常见的原因是存在巨大肿瘤和/或肿瘤侵犯相邻结构（16/158）、既往手术导致的粘连（8/158）或患者肥胖（5/158）。有31例并发症（19.6%），其中9例需要再次手术。仅1例复发（0.9%），在术后15个月出现，位于套管针穿刺部位和引流部位，并伴有腹膜癌转移。这发生在1例直肠肿瘤患者，术中直肠穿孔，肠内容物外溢。切除标本中平均获取淋巴结数为12.8个（范围1 - 41个），肿瘤距近端切缘平均距离为11.5 cm（范围5 - 35 cm），距远端切缘平均距离为7.5 cm（范围1 - 25 cm）。平均手术时间为165分钟（范围40 - 360分钟），平均住院时间为9.2天（范围6 - 40天）。158例患者中有3例死亡（1.9%）。
在严格遵循肿瘤学原则的前提下进行腹腔镜结肠恶性病变切除术，已表明难以形成防止壁层和腔内复发的屏障。我们认为，复发是由手术技术不当引起的。因此，腹腔镜结肠肿瘤手术必须由经过挑选的专业中心进行。
