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腹腔镜与结肠镜双镜结合治疗结直肠息肉的疗效发布时间：2022-09-28T07:27:14.028Z 来源：《中国医学人文》2022年12期作者：刘少杰[导读] 目的分析结直肠息肉采用双镜结合（腹腔镜与结肠镜）的效果。
方法选取本院2021年3月－1刘少杰黑龙江省肇源县中医院 166500【摘要】目的分析结直肠息肉采用双镜结合（腹腔镜与结肠镜）的效果。
方法选取本院2021年3月－11月期间收治的62例结直肠息肉患者进行研究，并采取随机双盲法将其分为对照组和观察组，每组各31例，给予对照组结肠镜切除术，给予观察组腹腔镜联合结肠镜切除术，对比两组疗效。
结果观察组临床指标、并发症发生率优于对照组，差异具有统计学意义（P＜0.05）。
结论结直肠息肉患者采用双镜结合（腹腔镜与结肠镜）切除术，能快速恢复，出现并发症的概率较小，值得推广。
【关键词】结直肠息肉；腹腔镜；结肠镜；临床指标；并发症发生率[Abstract] Objective To analyze the effect of combined laparoscopy and colonoscopy on colorectal polyps. Methods 62 patients with colorectal polyps treated in our hospital from March to November 2021 were selected for study. They were randomly divided into control group and observation group with 31 cases in each group. The control group was given colonoscopy resection, and the observation group was given laparoscopy combined with colonoscopy resection. The curative effects of the two groups were compared. Results the clinical indexes and the incidence of complications in the observation group were better than those in the control group (P. Conclusion the patients with colorectal polyps can recover quickly and the probability of complications is small, so it is worth popularizing.【 key words 】 colorectal polyps; Laparoscopy; Colonoscopy; Clinical indicators; Complication rate结直肠息肉如果没有得到及时有效的治疗，会由增生发展成为腺瘤，最终发生癌变，其中多发性息肉、不典型增生等是导致结直肠息肉发生癌变的高危因素，为了避免结直肠息肉发生癌变，结直肠息肉患者需要在早期实施切除术【1】。
观察腹腔镜联合结肠镜下手术治疗结直肠息肉的临床效果目的：观察腹腔镜联合结肠镜下手术治疗结直肠息肉的临床效果。
方法：对2005年11月至2015年4月期间来本院就诊的50例结直肠息肉患者的临床资料进行回顾性分析，患者均接受腹腔镜联合结肠镜下手术切除息肉，总结手术方法，并观察临床效果。
结果：本组患者中首次手术成功为92%（46/50），2次手术成功为100%（4/4），临床效果方面治愈86%（43/50），有效14%（7/50），总有效率为100%。
未见肠狭窄、腹部压痛、腹泻以及反跳痛等严重并发症发生，无复发病例。
手术时间为40～95min，平均手术时间（73.2±15.9）min；术中出血20～50mL，平均出血（31.2±23.4）mL；肠功能恢复时间23～30h，平均（28.3±11.7）h；住院时间5～9d，平均住院时间（6.3±5.5）d。
结论：腹腔镜联合结肠镜下手术治疗结直肠息肉的临床效果确切，安全性高，患者痛苦较少，恢复快，并发症几率低，操作简便，极具临床应用价值。
标签：腹腔镜；结肠镜；结直肠息肉目前结直肠息肉复发率较高，其病因尚未明确，可能与遗传、长期炎症、腹泻或便秘关系密切[1]。
结肠镜检查是临床诊治息肉的主要手段，并通过手术切除来治疗结直肠息肉，但可能引起一系列并发症，如肠狭窄、腹部压痛、腹泻以及反跳痛等。
引入腹腔镜后，临床治疗得到很大改观，不仅创伤较小，而且患者康复较快，术后并发症与复发率都得到有效控制，住院时间也大大减小，因此受到越来越多的患者的接受。
本研究对2005年11月至2015年4月期间来本院就诊的50例结直肠息肉患者的临床资料进行回顾性分析，以进一步对腹腔镜联合结肠镜下手术治疗结直肠息肉的临床效果进行说明，现报告如下。
1 资料与方法1.1 临床资料对2005年11月至2015年4月期间来本院就诊的50例结直肠息肉患者的临床资料进行回顾性分析，其中男性患者26例，女性患者24例，年龄为34～67岁，平均年龄（49.11±10.36）岁，降结肠15例，直肠11例，乙状结肠8例，横结肠16例。
结肠镜联合腹腔镜治疗结直肠息肉疗效观察林建园;群英英;钟远慎;董功航;高朝腾;余宗洋【摘要】Objective To explore the safety and clinical efficacy of colonoscopy combined with laparo-scope in the treatment of colorectal polyps, and to provide theoretical basis for the effective treatment of colorectal polyps. Methods A total of 80 patients with colorectal polyps (confirmed as benign by biopsy), who underwent lapa-roscopic colectomy in Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University from January 2012 to February 2014, were selected. Patients were randomly divided into observation group and control group, with 40 pa-tients in each group. The observation group underwent colonoscopy combined with laparoscopic resection, and the con-trol group underwent open cholecystectomy. The operation time, length of stay, bleeding during operation, and recov-ery time of bowel function between the two groups were compared. At the same time, the relationship between the di-ameter of the polyp, the quantity and the malignant transformation were explored. Results The operation time, bleed-ing during operation and recovery time of intestinal peristalsis in observation group were respectively (84.7 ± 17.2) min, (33.7±9.8) mL and (6.7±2.4), which were significantly less than those in control group of (107.2±22.7) min, (117.5± 21.6) mL and (8.5±4.9), and the differences were statistically significant (P<0.05). The bleeding during operation in observation group was significantly lower than that in control group, and the difference was statistically significant (P<0.05). Pathologicalanalysis showed that malignant transformation rate of colorectal polyps with diameter≥2 cm reached to 47%, but that of the ones with diameter<2 cm was 7.1%only. There were statistically significant differ-ences between the two groups (P<0.05). The malignant transformation rate of single polyp was 4.3%, and the malig-nant transformation rate of multiple polyps was 38.1%, with statistically significant differences between the two groups (P<0.05). There were no serious complications in both groups. Conclusion Colonoscopy combined with laparoscopy in treatment of colorectal polyps can significantly shorten the operation time, length of stay, and bowel function recovery time.%目的：探讨结肠镜联合腹腔镜治疗结直肠息肉的安全性和临床疗效，为临床医生有效治疗结直肠息肉提供理论依据。
腹腔镜与开腹手术治疗结直肠癌的临床效果比较发布时间：2021-01-18T02:40:00.074Z 来源：《医药前沿》2020年28期作者：应大钦1 苏春梅2 [导读] 故而该手术方案逐渐被临床医师采纳。
本文报道腹腔镜治疗结直肠癌的临床疗效报道如下。
（1四川省雅安市人民医院普外科四川雅安 625000）（2四川省雅安市人民医院放射科四川雅安 625000）【摘要】目的：比较腹腔镜与开腹手术治疗结直肠癌效果差异。
方法：选取2014年3月—2016年12月100例在我院治疗的直肠癌患者为对象。
随机分为两组，其中研究组50例患者接受腹腔镜术，对照组50例患者接受开腹术。
对比两组手术时间、术中出血量和切口大小等指标，对比两组术后排气时间及住院时间、术后并发症和术后平均无进展生存时间与平均总生存期。
结果：研究组在手术时间、术中出血量、切口大小与对照组有显著差异（P<0.05）；两组术后排气时间、住院时间上有显著差异（P<0.05）；研究组和对照组术后并发症发生率分别为0.00%、12.00%，两组有显著差异（P<0.05）；研究组和对照组平均进展生存时间、平均总生存期分别为（13.56±1.51）月、（26.39±3.74）月和（8.37±1.21）月、（21.34±2.93）月，比较有差异（P<0.05）。
结论：腹腔镜治疗结直肠癌上疗效肯定，手术创伤小，术后恢复快，生存期长。
【关键词】腹腔镜；开腹；结直肠癌【中图分类号】R735.34 【文献标识码】A 【文章编号】2095-1752（2020）28-0021-03 To explore the clinical effect of laparoscopic and open surgery on colorectal cancer Ying Daqin1, Su Chunmei21 Department of General Surgery, Sichuan Ya'an People's Hospital, Ya'an, Sichuan 625000,China2 Department of Radiology, Sichuan Ya'an People's Hospital, Ya'an, Sichuan 625000,China【Abstract】Objective To explore the clinical differences between laparoscopic and laparoscopic surgery for colorectal cancer. Methods From March 2014 to December 2016, 100 patients with rectal cancer treated in our hospital were selected as the research objects. They were randomly divided into two groups, 50 patients in the study group received laparoscopic surgery, and 50 patients in the control group received laparotomy. The operation related indexes, postoperative exhaust time and hospitalization time, postoperative complications, mean progression free survival time and average overall survival time were compared between the two groups.Results The operation time, intraoperative blood loss, and incision size of the study group were significantly different from those of the control group (P<0.05); the postoperative exhaust time and hospitalization time of the two groups were significantly different (P<0.05); the study group and The incidence of postoperative complications in the control group was 0.00% and 12.00%, respectively, and there was a significant difference between the two groups (P<0.05); the above indexes of the study group and the control group were (13.56±1.51 month, 26.39±3.74 month), (8.37±1.21 month, 21.34±2.93 month), there is a difference (P<0.05). Conclusion Laparoscopy has a positive effect on colorectal cancer, with less surgical trauma, quick postoperative recovery, and long survival time.【Key words】Laparoscopy; Laparotomy; Colorectal cancer结直肠癌是最常见的消化道恶性肿瘤之一，相关研究显示结直肠癌为全球第三大恶性肿瘤，在欧洲居肿瘤发病的第1～2位，美国居肿瘤发病的第3位，2008年中国结直肠癌病例总数为22.1万[1]。
对比腹腔镜根治术与传统开腹手术治疗结肠癌的临床效果研究【摘要】目的：分析比较结肠癌实施传统开腹手术、腹腔镜根治术的效果。
方法：于2020年1月-2022年1月抽取结肠癌手术患者54例开展调查，随机分组，27例/组，其中实施传统开腹手术组、腹腔镜根治术组分别以对照组、观察组表示，对比分析两组治疗效果。
结果：两组手术时间对比差异小（P＞0.05），与对照组比较，观察组手术出血量少，淋巴结清除数多，手术时间、肠蠕动恢复时间、恢复下床活动时间、住院时间短，（P＜0.05）。
与对照组比较，观察组并发症率低，（P＜0.05）。
术后3个月、半年两组复发率与死亡率对比差异小（P＞0.05），术后1年与对照组比较，观察组复发率与死亡率低，（P＜0.05）。
结论：传统开腹术创伤大的缺陷明显不利于术后恢复，与之相比腹腔镜根治术的损伤更小，患者更容易获得满意预后。
【关键词】结肠癌；传统开腹手术；腹腔镜根治术；并发症To compare the clinical effect of laparoscopic radical operation and traditional open operation on colon cancerLi XijingSichuan Liangshan Yi Autonomous Prefecture Integrated Traditional Chinese and Western Medicine Hospital 615000[Abstract] Objective: To analyze and compare the effects of traditional laparotomy and laparoscopic radical resection for colon cancer. Methods: From January 2020 to January 2022, 54 patients undergoing colon cancer surgery were selected for investigation and randomly pided into 27 patients/group. The traditional open surgery group and laparoscopic radical surgery group were respectivelyexpressed as control group and observation group, and the therapeutic effects of the two groups were compared and analyzed. Results: There was little difference in operative time between the two groups (P >0.05). Compared with the control group, the observation group had less operative blood loss, more lymph node clearance, shorter operative time, recovery time of intestinal peristalsis, recovery time ofgetting out of bed and shorter hospital stay (P < 0.05). Compared with the control group, the complication rate in the observation group was lower (P < 0.05). There was little difference in recurrence rate and death rate between the two groups 3 months and 6 months after surgery (P > 0.05), and the observation group had lower recurrence rate and death rate 1 year after surgery compared with the control group (P <0.05). Conclusion: The defects of traditional laparotomy with large trauma are obviously not conducive to postoperative recovery. Compared with laparoscopic radical surgery, the injury is less, and patientsare more likely to obtain a satisfactory prognosis.【 Key words 】 colon cancer; Traditional open surgery; Laparoscopic radical surgery; complications结肠癌患病率正处于增长中，严重程度不同、病灶位置不同，患者的症状表现也有所不同，在转移后还会侵袭其他器官引发功能障碍性问题[1]。
80例结直肠息肉患者行腹腔镜联合结肠镜治疗临床探讨目的：探讨结肠镜联合腹腔镜下治疗结肠息肉的临床疗效研究。
方法：对80例无法在结肠镜下完整切除结肠息肉及结肠镜下切除可能出现并发症的患者，采用结肠镜引导联合腹腔镜切除治疗。
结果：所有患者手术均顺利完成，无出血、穿孔及狭窄等并发症发生。
术后患者息肉病理类型检查表明绒毛状管状腺瘤癌变率较管状腺瘤明显提高，癌变率随息肉增大而增加。
结论：结肠镜与腹腔镜联合应用发挥各有优势相互辅助，提高了手术的安全性，避免了并发症的发生及减少了手术创伤。
标签：结肠息肉；结肠镜；腹腔镜中图分类号R735.3 文献标识码 B 文章编号1674-6805(2012)21-0135-02结肠息肉及早进行治疗是降低其发生癌变的有效措施，患者多在行结肠镜检查时被发现和切除，但对于较大、多发广基息肉或息肉基底位于黏膜深部等情况结肠镜难以完整切除治疗，若强行切除则可能发生肠漏、肠穿孔等严重并发症[1]。
而单纯行腹腔镜术中定位困难，其联合结肠镜可提供准确的定位同时切除息肉，提高了安全性。
本文对2008年10月-2010年9月笔者所在科应用结肠镜联合腹腔镜治疗80例结肠镜下切除困难的结肠息肉患者，现报告如下。
1资料与方法1.1一般资料选择80例结肠镜下切除困难的结肠息肉患者，男52例，女28例，年龄37～76岁，均有排便习惯改变，部分患者时有便血发生。
其中有蒂息肉49例，无蒂息肉31例。
横结肠息肉21例，降结肠息肉14例，乙状肠息肉45例，其基底部直径均>1.0 cm。
术前均先行结肠镜取病理检查证实：其中绒毛状管状腺瘤48例，管状腺瘤26例，幼年性息肉6例。
1.2手术方法患者术前1 d进流质饮食，于番泻叶、硫酸镁、生理盐水、肠道抗生素及甲硝唑口服，并于术前晚清洁灌肠。
取截石位及采用气管插管全麻，脐部上缘穿刺建立CO2气腹，以12～13 mm Hg维持腹压，或切开腹部插入30°腹腔镜后行常规腹腔探查。
对比腹腔镜结直肠癌根治术与开腹手术治疗结直肠癌患者近期临床疗效发布时间：2022-09-28T09:27:22.747Z 来源：《医师在线》2022年13期作者：吴博[导读] 目的：分析确诊结直肠癌患者在临床治疗期间选择不同手术治疗效果。
吴博高县中医医院四川宜宾 645150【摘要】目的：分析确诊结直肠癌患者在临床治疗期间选择不同手术治疗效果。
方法：2019年3月至2022年4月期间（近3年）入院就诊82例患者（确诊结直肠癌）作为此次分析对象，根据开展治疗方式差异划分成对等人数两组（对照组与观察组，41/例）并以此开展开腹术及腹腔镜术治疗，对两组治疗后临床差异比较。
结果：观察组治疗后除手术时间、近期疗效偏高，炎症因子指标水平、其余手术指标差均平均偏低，（p＜0.05）。
结论：相较于开腹术治疗结直肠癌患者，临床更倾向于选择腹腔镜结直肠癌根治术，其突出优势包括：安全性高、住院时间短、术中出血量少、肠功能恢复快、疗效显著等，为后期临床治疗此疾病患者予以一定参考数据支持。
【关键词】结直肠癌；开腹术；腹腔镜术；安全性在恶性肿瘤疾病类型中结直肠癌发病率较高，体重减轻、腹泻、排便习惯改变及贫血使其主要临床表现[1]。
现如今，该疾病因人们生活习惯的改变显著上涨，严重影响患者日常生活及身心健康。
当前，临床针对该疾病以手术治疗为主，包括腹腔镜结直肠癌根治术、开腹术，两种方式疗效存在显著差异[2]。
鉴于此，本研究分析确诊结直肠癌患者在临床治疗期间选择不同手术治疗效果，内容如下。
1资料与方法1.1一般资料2019年3月至2022年4月期间（近3年）入院就诊82例患者（确诊结直肠癌）作为此次分析对象，根据开展治疗方式差异划分成对等人数两组（对照组与观察组，41/例）并以此开展开腹术及腹腔镜术治疗。
对照组（男：女=25:16），年龄范围46~79岁，均数值（56.74±6.51）岁。
观察组（男：女=28:13），年龄范围47~80岁，均数值（56.81±6.22）岁。
·论著·腹腔镜联合结肠镜手术与开腹手术治疗特殊类型结直肠息肉的临床研究陈木龙颜松龄张国伟孙广文闫一飞【摘要】目的探讨腹腔镜联合结肠镜手术（双镜手术）与开腹手术治疗特殊类型结直肠息肉的优缺点。
方法回顾性分析62例实施手术治疗的特殊类型结直肠息肉（宽基无蒂、特殊部位或怀疑癌变，内镜下切除困难或存在较大风险）患者的临床资料，其中实施双镜手术42例（双镜组），开腹手术20例（开腹组）。
比较两组患者的手术时间、术中出血量、术后排气时间、术后住院时间和并发症发生率等。
结果两组均无手术失败病例，均成功切除息肉病灶，无手术相关死亡病例。
双镜组无中转开腹病例。
开腹组2例单纯依靠手的触摸感未能确定病灶位置，遂借助术中结肠镜予以成功定位。
双镜组手术时间、术中出血量、术后排气时间、术后住院时间和并发症发生率均明显小于开腹组［（60.5±25.4）min比（75.8±20.6）min、（30.5±15.8）ml比（55.2±24.6）ml、（24.6±10.5）h比（40.5±16.8）h、（3.2±1.0）d比（5.8±2.2）d、0比20%（4/20）］，差异有统计学意义（P＜0.05）。
其中开腹组术后早期炎性肠梗阻1例、腹腔感染1例、切口感染2例，经保守治疗痊愈。
随访3～36（18.6±12.3）个月，所有患者均存活，两组均未发生复发和转移，无吻合口狭窄和吻合口瘘等并发症。
结论对于特殊类型的结直肠息肉，双镜手术较开腹手术创伤小、恢复快、并发症少，是内镜下切除之外的首选治疗方式。
【关键词】肠息肉；腹腔镜；结肠镜；剖腹术；回顾性研究Clinical study of laparoscopic combined with colonoscopic surgery and open surgery in thetreatment of special types of colorectal polyps Chen Mulong,Yan Songling,Zhang Guowei,SunGuangwen,Yan Yifei.Department of Gastrointestinal Surgery,the Second Hospital of Xiamen City,FujianXiamen361021,ChinaCorresponding author:Chen Mulong,Email:dragon9951n@[Abstract]Objective To explore the advantages and disadvantages of laparoscopic combinedwith colonoscopic surgery(double endoscope surgery)and open surgery in the treatment of special typesof colorectal polyps.Methods The clinical data of62patients with special types of colorectal polyps(wide base sessile,special parts or suspected cancerous,endoscopic resection difficult or high risk)were retrospectively analyzed.Among them,42patients underwent double endoscope surgery(double endoscope group),and20patients underwent open surgery(open group).The operating time,amount ofbleeding during operation,postoperative exhaust time,postoperative hospital stay and complication ratewere compared between2groups.Results All the patients had successful resection of the polyps,andthere were no operative deaths.There was no conversion to open surgery in double endoscope group.Twopatients in the open group were unable to locate the lesion by the tactile sensation of the hand and thensucceeded in locating by intraoperative colonoscopy.The operating time,amount of bleeding during operation,postoperative exhaust time,postoperative hospital stay and complication rate in double endoscope group were significantly lower than those in open group:(60.5±25.4)min vs.(75.8±20.6)min,(30.5±15.8)ml vs.(55.2±24.6)ml,(24.6±10.5)h vs.(40.5±16.8)h,(3.2±1.0)d vs.(5.8±2.2)dand0vs.20%(4/20),and there were statistical differences(P＜0.05).There was1case with early postoperative inflammatory bowel obstruction,1case with abdominal infection and2cases with incisionDOI：10.3760/cma.j.jssn.1673-4904.2016.06.018作者单位：361021厦门市第二医院胃肠外科通信作者：陈木龙，Emial：dragon9951n@infection in open group.There was no operative death in the two groups,and these patients were cured by conservative treatment.The follow-up time was3－36(18.6±12.3)months,and all the patients survived. The patients in2groups had no recurrence and metastasis,no anastomotic stenosis,anastomotic leakage and other complications.Conclusions For the special types of colorectal polyps,double endoscope surgery is less invasive,with faster recovery and less complications.It is the first choice except for endoscopic resection.[Key words]Intestinal polyps;Laparoscopes;Colonoscopes;Laparotomy;Retrospective studies近年内镜治疗技术取得飞速发展，对于结直肠息肉治疗而言，除了传统的内镜下息肉摘除术之外，内镜下黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）等新兴技术显著扩大了适应证范围[1-2]。
但是，对于一些特殊类型的结直肠息肉，如宽基无蒂，位于结肠脾曲、肝曲或回盲部等特殊部位，以及多发息肉和怀疑癌变，仍然需要外科手术干预[3-4]。
同时，对于绝大多数基层医院短时期内尚难以具备和普及EMR、ESD等技术条件。
因此，目前外科手术依然在结直肠息肉治疗中继续扮演着重要角色。
为此，我们探讨特殊类型结直肠息肉外科干预时的合理方式。
资料与方法1.一般资料：2013年1月至2015年12月在我院接受外科手术治疗的特殊类型结直肠息肉患者62例，其中男35例，女27例，年龄24～71（57.3±15.8）岁。
息肉均为单发病灶，最大径1.7～3.6（2.4±1.1）cm。
入选标准：息肉为宽基无蒂、特殊部位或怀疑癌变；内镜下切除困难或存在较大风险；患者均自愿选择手术治疗。
排除标准：患有严重心脑血管疾病、精神障碍、严重肝肾功能不全以及其他无法耐受手术疾病等。
息肉位于结肠54例，直肠8例；回盲部6例，结肠肝曲13例，结肠脾曲15例，升结肠4例，横结肠2例，降结肠8例，乙状结肠6例，直肠上段8例。
其中行腹腔镜联合结肠镜手术（双镜手术）42例（双镜组），男24例，女18例，年龄（60.5±16.2）岁，息肉最大径（2.2±1.3）cm，结肠37例，直肠5例；行开腹手术（开腹组）20例，男11例，女9例，年龄（55.6±14.5）岁，息肉最大径（2.8±1.6）cm，结肠17例，直肠3例。
两组性别构成、年龄、息肉最大径和部位比较差异无统计学意义（P>0.05）。
2.术前检查：患者术前常规检查包括体格检查、肿瘤标志物检测、胸片、彩超（肝胆胰脾）和腹部增强CT等，评估淋巴结和远处转移情况。
3.手术方式：均在气管插管全身麻醉下手术。
双镜组患者采用三孔法腹腔镜操作，建立气腹后，先行腹腔内探查，再从肛门插入结肠镜进行病灶定位，通过灯光指引和指示性动作来定位病灶，定位成功后退出结肠镜，腹腔镜下分别行结肠楔形切除术（18例）、结肠肠段切除术（15例）、直肠肠段切除术（3例）、结肠癌根治术（4例）、直肠癌根治术（2例）。
开腹组患者开腹后，以手的触摸感来定位病灶，必要时借助术中结肠镜定位，定位成功后分别行结肠楔形切除术（10例）、结肠肠段切除术（5例）、直肠肠段切除术（2例）、结肠癌根治术（2例）、直肠癌根治术（1例）。
