The experience of laparoscopic low colorectal cancer radical operation through natural orifice(3 cases)

doi:10.3877/cma.j.issn.2095-3224.2015.02.16

Abstract

Key words: Surgical procedures, minimally invasive, Laparoscopes, Rectal neoplasms, Proctocolectomy, restorative

Bao-jia CAI, Cheng-wu ZHANG, Xiao-long WANG, Xiang-sheng WANG, Ji-zhe WANG, Li TAN. The experience of laparoscopic low colorectal cancer radical operation through natural orifice(3 cases)[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2015, 04(02): 179-181.

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组别	患者1	患者2	患者3
性别	男	男	女
年龄(岁)	71	65	61
入院时间	2014年10月7日	2014年11月4日	2014年12月31日
入院主诉	间断性腹泻3年，大便带血1月，加重1周	间断性腹泻半年，加重伴便血2月	下腹部不适3月，加重伴大便带血2月
腹部查体	未见异常	未见异常	未见异常
肛门指诊	取胸膝位，肛门口6点钟方向可见外痔。进指顺利，于距肛门约8 cm处，直肠壁11点-1点方向可触及隆起性肿块，触痛明显，质硬，活动度可，退指指套染血	取胸膝位，肛门外观正常，无红肿及破溃，无外痔及新生物。进指顺利，距肛门约5～6 cm处，直肠壁12点-6点方向可触及菜花样肿物下缘，触痛明显，质略硬，活动度欠佳，上缘未触及，退指指套染血	取胸膝位，肛门6点钟方向可见一痔疮。进指顺利，于距肛门约7 cm处，肠壁11点到1点方向可触及肿块下缘，触痛明显，质硬，活动度良好，退指指套染血
肠镜检查	结肠多发息肉(山田1级)，直肠息肉早癌可能	直肠溃疡浸润性癌，结肠多发息肉(山田1-2级)	直肠溃疡浸润型癌
肠镜病例结果	(直肠近肛门口)管状绒毛状腺瘤，部分腺体考虑腺癌，(直肠16 cm处)管状腺瘤，(乙状结肠、直肠进镜9 cm处)粘膜组织慢性炎，伴腺体呈腺瘤样增生	(直肠)粘膜腺癌	(直肠)粘膜腺癌
手术后病例结果	直肠隆起型中分化腺癌侵及深肌层，周围绒毛管状腺癌；肿瘤间质促纤维反应(＋)；淋巴浆细胞浸润(＋)；神经、脉管侵犯(－)；两切缘均(－)；(另送)吻合口及上切缘均(－)；肿物周淋巴结未见癌转移(0/3)	直肠管状溃疡型中分化腺癌侵及浅肌层；肿瘤间质促纤维反应(＋)；淋巴浆细胞浸润(＋＋)；脉管内瘤栓(-)；神经侵犯(-)；两切缘(-)；吻合口(-)；切缘(-)；肠系膜淋巴结未见癌转移(0/9)；另送肠系膜淋巴结未见癌转移(-)	直肠盘状管状高分化腺癌，侵及深肌达外膜；肿物周促纤维反应(＋)；淋巴浆细胞浸润(＋)；脉管侵犯(-)；神经侵犯(-)；两切端(-)；另送吻合口(-)；上切缘(-)；肿物周淋巴结可见癌转移(2/9)

组别	患者1	患者2	患者3
性别	男	男	女
年龄(岁)	71	65	61
入院时间	2014年10月7日	2014年11月4日	2014年12月31日
入院主诉	间断性腹泻3年，大便带血1月，加重1周	间断性腹泻半年，加重伴便血2月	下腹部不适3月，加重伴大便带血2月
腹部查体	未见异常	未见异常	未见异常
肛门指诊	取胸膝位，肛门口6点钟方向可见外痔。进指顺利，于距肛门约8 cm处，直肠壁11点-1点方向可触及隆起性肿块，触痛明显，质硬，活动度可，退指指套染血	取胸膝位，肛门外观正常，无红肿及破溃，无外痔及新生物。进指顺利，距肛门约5～6 cm处，直肠壁12点-6点方向可触及菜花样肿物下缘，触痛明显，质略硬，活动度欠佳，上缘未触及，退指指套染血	取胸膝位，肛门6点钟方向可见一痔疮。进指顺利，于距肛门约7 cm处，肠壁11点到1点方向可触及肿块下缘，触痛明显，质硬，活动度良好，退指指套染血
肠镜检查	结肠多发息肉(山田1级)，直肠息肉早癌可能	直肠溃疡浸润性癌，结肠多发息肉(山田1-2级)	直肠溃疡浸润型癌
肠镜病例结果	(直肠近肛门口)管状绒毛状腺瘤，部分腺体考虑腺癌，(直肠16 cm处)管状腺瘤，(乙状结肠、直肠进镜9 cm处)粘膜组织慢性炎，伴腺体呈腺瘤样增生	(直肠)粘膜腺癌	(直肠)粘膜腺癌
手术后病例结果	直肠隆起型中分化腺癌侵及深肌层，周围绒毛管状腺癌；肿瘤间质促纤维反应(＋)；淋巴浆细胞浸润(＋)；神经、脉管侵犯(－)；两切缘均(－)；(另送)吻合口及上切缘均(－)；肿物周淋巴结未见癌转移(0/3)	直肠管状溃疡型中分化腺癌侵及浅肌层；肿瘤间质促纤维反应(＋)；淋巴浆细胞浸润(＋＋)；脉管内瘤栓(-)；神经侵犯(-)；两切缘(-)；吻合口(-)；切缘(-)；肠系膜淋巴结未见癌转移(0/9)；另送肠系膜淋巴结未见癌转移(-)	直肠盘状管状高分化腺癌，侵及深肌达外膜；肿物周促纤维反应(＋)；淋巴浆细胞浸润(＋)；脉管侵犯(-)；神经侵犯(-)；两切端(-)；另送吻合口(-)；上切缘(-)；肿物周淋巴结可见癌转移(2/9)

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