Poulin E C, Schlachta C M, Mamazza J, Seshadri P A
University of Toronto Centre for Minimally Invasive Surgery, St. Michael's Hospital, Ontario, Canada.
Dis Colon Rectum. 2000 May;43(5):621-6; discussion 626-7. doi: 10.1007/BF02235574.
The aim of this study was to study a group of consecutive patients with enteric fistulas treated by laparoscopic surgery and to compare outcomes with a matched group of patients treated by open surgery.
The outcomes of 13 patients with Crohn's disease or sigmoid diverticulitis with enteric fistulas treated laparoscopically (Group I) were compared with 13 patients matched for age, weight, gender, diagnosis, and characteristics of fistulas and treated by conventional surgery (Group II) during the same period.
No patient died postoperatively in either group. Mean operative time was 183 minutes in Group I vs. 154 minutes in Group II (P = 0.280). No significant difference was found between Groups I and II in the number of patients with major postoperative complications (3 vs. 5; P = 0.462), or postoperative stay (7.6 +/- 3.6 vs. 9.2 +/- 3 days; P = 0.239). Conversion to open laparotomy occurred in one (7.7 percent) patient from Group I. No patient required readmission for secondary surgery in Group I, and two patients were readmitted and underwent reoperation for complications in Group II (P = 0.462).
The laparoscopic treatment of selected cases of enteric fistulas is safe. Although most good outcome trends favor the laparoscopic group, the study is inconclusive, because no statistical difference was demonstrated with regard to operative time, number of postoperative complications, readmission rate, and length of postoperative stay, most likely because of the small number of cases in each arm of the study. Study of a greater number of cases outside the learning curve of the laparoscopic surgeons would clarify this issue. Other outcomes, including cost, pain control, cosmesis, and return to activities of daily living, need to be included in the evaluation.
本研究旨在对一组接受腹腔镜手术治疗的连续性肠瘘患者进行研究，并将其结果与一组接受开放手术治疗的匹配患者进行比较。
将13例患有克罗恩病或乙状结肠憩室炎并伴有肠瘘且接受腹腔镜治疗的患者（第一组）与同期13例在年龄、体重、性别、诊断以及瘘管特征方面相匹配且接受传统手术治疗的患者（第二组）的结果进行比较。
两组患者术后均无死亡病例。第一组平均手术时间为183分钟，第二组为154分钟（P = 0.280）。第一组和第二组术后主要并发症患者数量（3例对5例；P = 0.462）或术后住院时间（7.6±3.6天对9.2±3天；P = 0.239）方面均未发现显著差异。第一组有1例（7.7%）患者转为开腹手术。第一组无患者因二次手术需再次入院，第二组有2例患者因并发症再次入院并接受了再次手术（P = 0.462）。
对部分肠瘘病例进行腹腔镜治疗是安全的。尽管大多数良好的结果趋势有利于腹腔镜组，但该研究尚无定论，因为在手术时间、术后并发症数量、再入院率和术后住院时间方面未显示出统计学差异，这很可能是由于研究每组中的病例数量较少。对更多超出腹腔镜外科医生学习曲线的病例进行研究将阐明这一问题。评估还应纳入其他结果，包括成本、疼痛控制、美容效果和恢复日常生活活动能力等。
