Marcello P W, Milsom J W, Wong S K, Hammerhofer K A, Goormastic M, Church J M, Fazio V W
Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio, USA.
Dis Colon Rectum. 2000 May;43(5):604-8. doi: 10.1007/BF02235570.
A laparoscopic approach to restorative proctocolectomy is new and has not been compared recently with the traditional open procedure. By using prospectively gathered data, laparoscopic and open restorative proctocolectomy procedures in mucosal ulcerative colitis and familial adenomatous polyposis patients were compared by using a case-matched design.
Forty patients, composing 20 consecutive laparoscopic cases (13 mucosal ulcerative colitis, 7 familial adenomatous polyposis), were matched for age, gender, and body mass index with 20 open cases (13 mucosal ulcerative colitis, 7 familial adenomatous polyposis) performed during the same time period. Mucosal ulcerative colitis patients were also matched for severity of disease by using hemoglobin and albumin levels, whole blood count, and steroid dependency. A loop ileostomy was made in 12 of 13 laparoscopic mucosal ulcerative colitis patients, all open mucosal ulcerative colitis patients, and no familial adenomatous polyposis patients.
The median age was 25 (range, 9-61) years. There were no intraoperative complications in either group and no conversions in the laparoscopic group. The operative times (median, range) were significantly longer in laparoscopic cases (330, 180-480 minutes) vs. open cases (230, 180-300 minutes), P < 0.001. Bowel function returned more quickly in laparoscopic cases (2, 1-8 days) vs. open cases (4, 1-13 days), P = 0.03; and the length of stay was shorter in laparoscopic cases (7, 4-14 days) vs. open cases (8, 6-17 days), P = 0.02. For diverted patients, the median length of stay was reduced by two days in laparoscopic cases (6, 4-14 days) vs. open cases (8, 6-17 days), P = 0.01. Complications occurred in 4 of 20 laparoscopic patients (3 obstruction/ileus and 1 pelvic abscess) and 5 of 20 open patients (2 obstruction and ileus, 1 each anastomotic leak and abscess, peptic ulceration, and episode of dehydration).
Return of intestinal function and length of stay are reduced in the laparoscopic group compared with open group. A laparoscopic approach to restorative proctocolectomy has the potential of becoming an appealing alternative to conventional restorative proctocolectomy surgery.
腹腔镜下进行结直肠全切除回肠贮袋肛管吻合术是一种新方法，且最近未与传统开放手术进行比较。通过前瞻性收集数据，采用病例匹配设计，对黏膜溃疡性结肠炎和家族性腺瘤性息肉病患者的腹腔镜和开放结直肠全切除回肠贮袋肛管吻合术进行比较。
40例患者，包括连续20例腹腔镜手术病例（13例黏膜溃疡性结肠炎，7例家族性腺瘤性息肉病），在年龄、性别和体重指数方面与同期进行的20例开放手术病例（13例黏膜溃疡性结肠炎，7例家族性腺瘤性息肉病）相匹配。黏膜溃疡性结肠炎患者还根据血红蛋白和白蛋白水平、全血细胞计数以及类固醇依赖情况在疾病严重程度上进行匹配。13例腹腔镜黏膜溃疡性结肠炎患者中的12例、所有开放黏膜溃疡性结肠炎患者以及无家族性腺瘤性息肉病患者均进行了袢式回肠造口术。
中位年龄为25岁（范围9 - 61岁）。两组均无术中并发症，腹腔镜组无中转开腹情况。腹腔镜手术病例的手术时间（中位数，范围）显著长于开放手术病例（330分钟，180 - 480分钟 vs. 230分钟，180 - 300分钟），P < 0.001。腹腔镜手术病例的肠道功能恢复更快（2天，1 - 8天），而开放手术病例为（4天，1 - 13天），P = 0.03；腹腔镜手术病例的住院时间更短（7天，4 - 14天），开放手术病例为（8天，6 - 17天），P = 0.02。对于行造口术的患者，腹腔镜手术病例的中位住院时间比开放手术病例缩短了两天（6天，4 - 14天 vs. 8天，6 - 17天），P = 0.01。20例腹腔镜手术患者中有4例出现并发症（3例肠梗阻/肠麻痹和1例盆腔脓肿），20例开放手术患者中有5例出现并发症（2例肠梗阻和肠麻痹，各1例吻合口漏、脓肿、消化性溃疡和脱水发作）。
与开放组相比，腹腔镜组肠道功能恢复和住院时间缩短。腹腔镜下结直肠全切除回肠贮袋肛管吻合术有可能成为传统结直肠全切除回肠贮袋肛管吻合术的一种有吸引力的替代方法。
