中国实用外科杂志

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正确认识腹腔镜结直肠手术的中转开放手术

张忠涛,杨    鋆,冯哲文   

  1. 首都医科大学附属北京友谊医院普外科 国家消化系统疾病临床研究中心普外分中心,北京 100050
  • 出版日期:2022-11-01

  • Online:2022-11-01

摘要: 腹腔镜中转开放手术是手术医师制定手术方案、与病人和家属沟通时不可忽视的话题。从保障病人安全及获益等因素出发,恰当且及时地选择腹腔镜中转开放手术,可以降低潜在的临床并发症和不良肿瘤学结局的风险。在腹腔镜结直肠手术中,当存在肿瘤分期较晚、肿瘤巨大难以行腹腔镜切除等肿瘤学因素;解剖变异、肿瘤位置、肥胖、腹腔粘连等客观因素;术者技术不熟练、解剖不清晰等主观因素;以及出现术中难以控制的出血、副损伤、皮下气肿、二氧化碳潴留、气体栓塞、重建困难等情况,术者应立即施行中转开放手术。所有术式和技术的应用首先应保证病人生命安全,并以病人的利益为中心。当病人生命安全受到威胁,或术者认为腹腔镜操作的风险大于开腹操作时,应果断行中转开放手术。

关键词: 中转开放手术, 结直肠癌, 腹腔镜

Abstract: The appropriate understanding of conversion to open surgery in laparoscopic colorectal surgery        ZHANG Zhong-tao, YANG Yun, FENG Zhe-wen. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases,Beijing 100050,China
Corresponding author: ZHANG Zhong-tao, E-mail:zhangzht@
ccmu.edu.cn
Abstract    Laparoscopic conversion to open surgery has become a topic that cannot be ignored when surgeons make surgical plans and communicate with patients and their family members. From the perspective of ensuring the safety and benefits of patients, appropriate and timely selection of converting laparoscopic surgery to open surgery can reduce the risk of potential clinical complications and adverse oncological outcomes. In laparoscopic colorectal surgery, when there are oncological factors such as late tumor stage and huge tumor that are difficult to be resected by laparoscopy; Objective factors such as anatomical variation, tumor location, obesity, and abdominal adhesion; Subjective factors such as insufficient skills of the operator and unclear anatomy; In case of uncontrollable bleeding, side injury, subcutaneous emphysema, carbon dioxide retention, gas embolism, and difficult reconstruction, the surgeon should immediately convert to open surgery. All the operations and applications of technology should first ensure patient safety and the interests of the patient as the center; if a patient's life safety is threatened, or performers think laparoscopic operation risk is greater than the open operation, resolute conversion to open surgery should be done.

Key words: conversion to open surgery, colorectal cancer, laparascopy