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首页> 外文期刊>Surgical Endoscopy >Laparoscopic colorectal surgery for neoplasm. A large series by a single surgeon.
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Laparoscopic colorectal surgery for neoplasm. A large series by a single surgeon.

机译：腹腔镜结肠直肠癌手术。由一个外科医生进行的一系列大手术。

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BACKGROUND: The value and efficacy of laparoscopic colorectal surgery has been validated by large multicenter, randomized, controlled trials. However the results of a large series by a single surgeon in a single center have yet to be reported. We reviewed the short-term outcome of our series of laparoscopic colorectal procedures to better define the learning curve for acquiring these skills. METHODS: Four hundred four patients with a colorectal neoplasm underwent laparoscopic surgery between August 1998 and December 2005. Surgery was performed under 8 to 10 cm H(2)O CO(2) pneumoperitoneum. Type of operation, time of operation, and estimated blood loss were compared for each level of lymph node dissection, and the rate and reason for conversion to open procedures were determined. Time to passage of flatus, hospital stay, and postoperative complications were recorded. The learning curve for right hemicolectomy, sigmoidectomy, and low anterior resection was calculated. RESULTS: Open conversion was required in 13 patients (3.2%). Uncontrollable bleeding occurred in four cases, and inability to divide the rectum because of adhesions or local invasion occurred in three. The time of operation for D3 level lymph node dissection was longer than for D2 in ileocecal resection, right hemicolectomy, and sigmoidectomy. Estimated blood loss was similar among the different types of operation. Blood loss of last 40 right hemicolectomies was less than in the first 40 cases, and the incidence of intraoperative complications in the first 40 sigmoidectomies was higher than subsequent cases. Time of operation, estimated blood loss, and number of complications did not change over time for low anterior resection. CONCLUSION: The large series performed by a single surgeon is consistent with large multicenter studies that have validated the superiority of laparoscopic colorectal surgery over conventional open procedures. The learning curve flattens out after about 40 cases of right hemicolectomy and sigmoidectomy.
机译：背景：腹腔镜结直肠癌手术的价值和疗效已通过大型多中心，随机，对照试验得到验证。但是，尚未报道单个外科医师在单个中心进行的大手术的结果。我们回顾了一系列腹腔镜结直肠手术的近期结果，以更好地定义学习这些技能的学习曲线。方法：1998年8月至2005年12月间，有404例大肠肿瘤患者接受了腹腔镜手术。手术在8至10 cm H（2）O CO（2）气腹下进行。比较了每种淋巴结清扫术的手术类型，手术时间和估计的失血量，并确定了转换为开放手术的速度和原因。记录了肠胀气的通过时间，住院时间和术后并发症。计算右半结肠切除术，乙状结肠切除术和低位前切除术的学习曲线。结果：13例患者（3.2％）需要进行开放式转换。四例发生无法控制的出血，三例发生由于粘连或局部浸润而无法分割直肠的情况。在回盲肠切除，右半结肠切除术和乙状结肠切除术中，D3级淋巴结清扫术的手术时间比D2长。在不同类型的手术中，估计失血量相似。最近40例右半结肠电切术的出血量少于前40例，并且在前40例乙状结肠切除术中术中并发症的发生率高于随后的病例。对于低位前切除术，手术时间，估计的失血量和并发症的数量不会随时间变化。结论：由单名外科医生进行的大系列手术与大型多中心研究一致，这些研究证实了腹腔镜结直肠癌手术优于传统开放手术的优势。在约40例右半结肠切除术和乙状结肠切除术后，学习曲线趋于平坦。

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