Panis Y
Service de Chirurgie Digestive, Hôpital Lariboisière - Paris.
J Chir (Paris). 2000 Oct;137(5):261-7.
Since 1991 when the first cases of laparoscopic colectomy were reported, this technique has become widespread in colorectal surgery. Its reliability in colorectal cancer has been demonstrated but indications must still be limited to strictly controlled clinical trials that will determine its impact in terms of cancerology outcome. Inversely, for benign colorectal disease, the efficacy, low morbidity and the generally observed clinical benefit of laparoscopy compared with laparotomy, particularly in terms of patient comfort in the post-operative period and delay to normal activities, has been clearly demonstrated in several, though too often uncontrolled, trials. Laparoscopy will thus become more and more widespread and probably predominant for benign colorectal disease. Today, it is warranted to propose first-intention laparoscopic procedures for elective diverticulitis sigmoidectomy, for ileocecal resection for Crohn's disease, for derivation stomies, and finally, for surgical ablation of voluminous colonic polyps. In hands well trained in laparoscopic and colorectal surgery, laparoscopic procedures will be proposed in the near future for total colectomy, rectopexia, or even ileo-anal anastomosis.
自1991年首次报道腹腔镜结肠切除术病例以来,这项技术在结直肠手术中已广泛应用。其在结直肠癌治疗中的可靠性已得到证实,但适应证仍必须限于严格对照的临床试验,以确定其在肿瘤学结局方面的影响。相反,对于良性结直肠疾病,与开腹手术相比,腹腔镜手术的疗效、低发病率以及普遍观察到的临床益处,特别是在术后患者舒适度和恢复正常活动的延迟方面,已在多项(尽管往往缺乏对照)试验中得到明确证实。因此,腹腔镜手术在良性结直肠疾病中将越来越普遍,甚至可能占主导地位。如今,对于择期乙状结肠憩室切除术、克罗恩病的回盲部切除术、转流造口术以及最后对于巨大结肠息肉的手术切除,建议首选腹腔镜手术。在腹腔镜和结直肠手术训练有素的医生手中,在不久的将来,对于全结肠切除术、直肠固定术甚至回肠肛管吻合术,也会建议采用腹腔镜手术。