Meijerink W J, Eijsbouts Q A, Cuesta M A, van Hogezand R A, Ringers J, Meuwissen S G, Griffioen G, Bemelman W A
Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Post Office Box 9600, 2300 RC Leiden, The Netherlands.
Surg Endosc. 1999 Sep;13(9):882-6. doi: 10.1007/s004649901125.
Laparoscopic bowel surgery was evaluated in 44 consecutive patients who underwent surgery for inflammatory bowel disease (IBD). We studied feasibility, results, and final outcome.
At two academic institutes, 44 laparoscopically assisted colectomies and laparoscopic ileostomies or colostomies were attempted. All patients had histologically proven IBD and no prior surgery for IBD. Loop ileostomy (n = 4), end colostomy (n = 1), ileocecal resection (n = 26) and (procto)colectomy (n = 13) were performed. All resections were laparoscopically assisted with extracorporal resection and anastomosis.
Only in two patients (ileocecal resection in both) was conversion to open surgery necessary. Two patients with laparoscopic ileocolic resection had intra-abdominal abscesses, which were drained percutaneously in both. One patient in the laparoscopically assisted colectomy group had a subphrenic abscess that was drained percutaneously, and one patient had a generalized candidiasis.
Laparoscopically assisted colectomies can be performed safely in treating IBD. The laparoscopic method with use of a small vertical umbilical or Pfannenstiel's incision seems acceptable with regard to operating time and overall costs, also allowing superior cosmesis to be maintained.
对44例因炎症性肠病（IBD）接受手术的连续患者进行了腹腔镜肠道手术评估。我们研究了其可行性、结果和最终结局。
在两家学术机构，尝试进行了44例腹腔镜辅助结肠切除术以及腹腔镜回肠造口术或结肠造口术。所有患者经组织学证实患有IBD，且既往未接受过IBD手术。进行了袢式回肠造口术（n = 4）、端结肠造口术（n = 1）、回盲部切除术（n = 26）和（直肠）结肠切除术（n = 13）。所有切除术均采用腹腔镜辅助，在体外进行切除和吻合。
仅2例患者（均为回盲部切除术）需要转为开腹手术。2例腹腔镜回结肠切除术患者发生腹腔内脓肿，均经皮引流。腹腔镜辅助结肠切除术组1例患者发生膈下脓肿，经皮引流，1例患者发生全身性念珠菌病。
腹腔镜辅助结肠切除术可安全用于治疗IBD。就手术时间和总体费用而言，采用小的脐部垂直切口或耻骨上横切口的腹腔镜方法似乎是可以接受的，同时也能保持较好的美容效果。
