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中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 14 -19. doi: 10.3877/cma.j.issn.1674-3946.2021.01.004

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中国腹腔镜直肠癌手术30年术后主要并发症防治策略
王贵英1,(), 胡旭华2, 张宁2, 李保坤2, 张建锋2, 周超熙2, 王光林2, 王飞飞2   
  1. 1. 050011 河北医科大学第四医院外二科;河北医科大学第三医院外科
    2. 050011 河北医科大学第四医院外二科
  • 收稿日期:2020-01-23 出版日期:2021-02-10
  • 通信作者: 王贵英

Prevention and therapeutic strategies of major complications after laparoscopic rectal cancer surgery, Chinese experience in the past 30 years

Guiying Wang1,(), Xuhua Hu2, Ning Zhang2, Baokun Li2, Jianfeng Zhang2, Chaoxi Zhou2, Guanglin Wang2, Feifei Wang2   

  1. 1. The Second Department of Surgery, the Fourth Hospital of Hebei Medical University; Department of Surgery, the Third Hospital of Hebei Medical University
    2. The Second Department of Surgery, the Fourth Hospital of Hebei Medical University
  • Received:2020-01-23 Published:2021-02-10
  • Corresponding author: Guiying Wang
  • Supported by:
    Key Project of Hebei Precision Medicine Joint Foundation(206Z7705G); Cancer Research Program of National Cancer Center(NCC2017A23); Key project of medical science research program of Hebei Province(20160194)
引用本文:

王贵英, 胡旭华, 张宁, 李保坤, 张建锋, 周超熙, 王光林, 王飞飞. 中国腹腔镜直肠癌手术30年术后主要并发症防治策略[J]. 中华普外科手术学杂志(电子版), 2021, 15(01): 14-19.

Guiying Wang, Xuhua Hu, Ning Zhang, Baokun Li, Jianfeng Zhang, Chaoxi Zhou, Guanglin Wang, Feifei Wang. Prevention and therapeutic strategies of major complications after laparoscopic rectal cancer surgery, Chinese experience in the past 30 years[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(01): 14-19.

随着腹腔镜器械的进步及手术技术的发展,腹腔镜直肠癌根治手术已经成为目前的主流术式。腹腔镜直肠癌手术能够提供更好的手术视野、更精细化的解剖认知、更小创伤的微创治疗理念,在国内外均获得了较好的临床疗效。此外随着大样本前瞻性随机对照试验(RCT)研究数据的发表,让我们也消除了腹腔镜直肠癌手术对于肿瘤学不良结局的顾虑。但是,腹腔镜直肠癌手术后的相关并发症仍临床治疗的难点和重点,也令外科医师们存在一定的敬畏。本文通过对近几年国内外文献的复习并结合我中心的治疗经验,以阐明腹腔镜直肠癌术后常见并发症类型、病因以及防治策略,为降低腹腔镜直肠癌术后并发症发生率提供更多的经验。

With the advancement of laparoscopic instruments and the development of surgical techniques, laparoscopic rectal cancer surgery has become the current mainstream operation. Laparoscopic rectal cancer surgery could provide better surgical vision, more refined anatomy, with less injury, and could achieve better clinical outcome both in China and abroad. Accumulated data from large-sample prospective randomized controlled trials (RCT) research eliminated the concept that laparoscopic rectal cancer surgery might result in a poor oncology outcome. However, complications related to laparoscopic rectal cancer surgery are still the challenge in clinical application for some surgeons. Based on domestic and foreign literatures in recent years and combined with the treatment experience of our center, this article clarifies the types of common complications, causes and prevention strategies after laparoscopic rectal cancer surgery, in order to provide reference to reduce the incidence of complications after laparoscopic rectal cancer surgery.

图1 吻合口漏典型病例(照片由河北医科大学第四医院外二科提供)。[男,63岁,腹腔镜下直肠癌根治术后6个月拟行回肠造口还纳入院,下消化道造影提示吻合口漏(A, B),电子结肠镜示吻合口狭窄,伴窦道形成(C)。]
表1 国际直肠癌研究组的吻合口漏分级[9]
图2 直肠癌术后吻合口狭窄球囊扩张后造影结果(照片由河北医科大学第四医院外二科提供)
图3 直肠癌术后吻合出血合并吻合口漏内镜下OTSC应用病例(照片由河北医科大学第四医院外二科提供)。[男,66岁,腹腔镜下直肠癌术后3 h,肛门便血200 ml,急诊内镜检查可见吻合口渗血(A),同时合并吻合口右后壁约1 cm漏口(B),行OTSC夹闭漏口及渗血肠壁(C)疗效确切,术后6月复查,可见吻合口愈合良好(D),伴部分金属夹残留。]
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