- 期刊
Laparoscopic Wedge Resection of Colorectal Adenomatous Polyps
大腸直腸腺瘤性瘜肉的腹腔鏡楔狀切除術
摘要
目的 過去大腸鏡無法切除之腺瘤性瘜肉常被視為剖腹切除之適應症。近來我們在大膽的協助下，已可藉著腹腔鏡技術準確且完整的切除這些病變。本文描述了此技術的步驟、適應症以及優缺點，同時回顧了本院的早期經驗。 方法 恩主公醫院大腸直腸外科自1999年12月到2001年7月共收集了8位大腸鏡無法切除之腺瘤性瘜肉病患接受腹腔鏡楔狀切除手術。在術中，腫瘤的定位、切除及大腸切口之縫合均在大腸鏡的協助下用腹腔鏡完成。 結果 本研究案例包括兩男六女，年齡介於49至81歲，腫瘤位於乙狀結腸（7位）及橫結腸（1位），大小介於1.5至4公分。所有案例手術順利並無改為剖腹的方式，且沒有產生併發症。平均手術時間約為143.8分鐘（手術時間由120至200分鐘），平均住院天數為5.5天。病理報告包括兩例管狀腺瘤、五例管狀絨毛腺瘤、一例中度分化腺癌（屬Haggitt level 1之腺癌），所有標本的切面邊緣均無腫瘤細胞。術後追蹤時間從23至42個月，所有病例均無腫瘤復發之現象。 結論 腹腔鏡楔狀切除術對於大腸鏡無法切除之大腸直腸腺瘤性瘜肉是另一安全可靠的處理方法。在合適的病人身上，它可以藉由大腸鏡的協助準確且完整的切除腫瘤，並有傷口較小、提早恢復正常生活及縮短住院時間之優點。
並列摘要
Purpose. Colorectal adennomatous polyps that were unlikely to be removed with colonoscope were believed to be an indication for open-segment resection before. With the guidance of colonoscopy, the laparoscopic procedure increases the safety of difficult polypectomy and also avoids a laparotomy or bowel resection as the alternative. This study describes the technique, evaluates which patients are most likely to be indicated and discusses the advantages and disadvantages of this procedure. Besides, a review of our experience is also provided. Methods. Between December 1999 and July 2001, eight patients diagnosed with colorectal polyps unsuitable for colonoscopic resection received operative treatment. Laparoscopy and colonoscopy were simultaneously used for tumor localization, resection and colostomy closure with intracorporeally sutures. Results. In our study, there were two men and six women with age ranged from 49 to 81 years. Lesions were located at the sigmoid colon (7 cases) and transverse colon (1 case) with sizes between 1.5 and 4 cm, respectively. There were no conversions to open surgery of all patients. The mean operative time was 143.8 minutes (range, 120-200 minutes). The patients passed flatus for the first time after a mean of 26.4 hours postoperatively. The median time of removal of nasogastric tubes from patients was 2 days, and patients commenced water intake on postoperative day 3 with soft diet on the following day. The median length of hospital stay was 5.5 days (range, 3-10 days). All drains were removed before being discharged. They all had uncomplicated postoperative outcome. Two tubular adenomas, five tubulovillous adenomas and one moderately differentiated adenocarcinoma (Haggitt level 1) were noted on histologic examination. Resection margins were free in all specimens. No tumor recurrence was observed by colonoscopy during the follow-up time from 23 to 42 months. Conclusions. Laparoscopic wedge resection is a safe alternative to colectomy in the management of larger or difficult colorectal adenomatous polyps. It provides many advantages, including smaller wounds, early return to full activity and short hospital stay. In a selected group of patients, we believe that it can provide accurate localization and radical resection of colorectal lesions under the assistance of colonoscopy.