克罗恩病的腹腔镜与开腹肠切除术

Laparoscopic versus open bowel resection for Crohn's disease.

作者信息

Tabet J, Hong D, Kim C W, Wong J, Goodacre R, Anvari M

机构信息

Department of Surgery, St Joseph's Hospital, McMaster University, Hamilton, Canada.

出版信息

Can J Gastroenterol. 2001 Apr;15(4):237-42. doi: 10.1155/2001/814749.

DOI:10.1155/2001/814749

PMID:11331925

Abstract

BACKGROUND

Laparoscopic bowel resection is an alternative to open surgery for patients with Crohn's disease requiring surgical resection. The present report describes a seven-year experience with the laparoscopic treatment of Crohn's disease compared with the open technique in a tertiary Canadian centre.

PATIENTS AND METHODS

A retrospective analysis of 61 consecutive patients undergoing elective resection for Crohn's disease was carried out between October 1992 and June 1999. This analysis included 32 laparoscopic resections (mean age 33 years) and 29 open resections (mean age 42 years). Patient demographics were compared, as well as short and long term outcomes after surgery (mean follow-up 39 months).

RESULTS

Patients in the laparoscopic group were younger and had fewer previous bowel surgeries than patients who had open resections. Indications for surgery and operative times were similar between the groups. Patients who underwent laparoscopic resections required fewer doses of narcotic analgesics. The resumption of bowel function after surgery, and tolerance of a clear liquid and solid diet was quicker in the laparoscopic group. Patients who underwent laparoscopic resections had significantly shorter hospital stays than those who underwent open resections. Fifteen patients (48.4%) in the laparoscopic group experienced recurrence of disease compared with 13 patients (44.8%) in the open group. In both groups, the most common site of recurrence was at the anastomosis. The disease-free interval was the same length for both groups (23.9+/-17.3 months for the laparoscopic resection patients compared with 23.9+/-20.2 months for the open resection patients; P=1.00).

CONCLUSIONS

Laparoscopic resection for Crohn's disease can be performed safely and effectively. Quicker resumption of oral feeds, less postoperative pain and earlier discharge from hospital are advantages of the laparoscopic method. No differences in the recurrence rate or the disease-free interval were noted.

摘要

背景

对于需要手术切除的克罗恩病患者，腹腔镜肠切除术是开腹手术的一种替代方法。本报告描述了在加拿大一家三级中心，腹腔镜治疗克罗恩病与开放技术相比的七年经验。

患者与方法

对1992年10月至1999年6月期间连续接受择期克罗恩病切除术的61例患者进行回顾性分析。该分析包括32例腹腔镜切除术（平均年龄33岁）和29例开腹切除术（平均年龄42岁）。比较了患者的人口统计学特征以及手术后的短期和长期结果（平均随访39个月）。

结果

腹腔镜组患者比开腹切除术患者更年轻，既往肠道手术次数更少。两组的手术指征和手术时间相似。接受腹腔镜切除术的患者所需的麻醉性镇痛药剂量更少。腹腔镜组术后肠功能恢复更快，对清流质和固体饮食的耐受性也更快。接受腹腔镜切除术的患者住院时间明显短于接受开腹切除术的患者。腹腔镜组有15例患者（48.4%）疾病复发，开腹组有13例患者（44.8%）复发。两组中，最常见的复发部位均为吻合口。两组的无病间期长度相同（腹腔镜切除术患者为23.9±17.3个月，开腹切除术患者为23.9±20.2个月；P = 1.00）。