Winslow E R, Fleshman J W, Birnbaum E H, Brunt L M
Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid, Campus Box 8109, St Louis, MO 63110, USA.
Surg Endosc. 2002 Oct;16(10):1420-5. doi: 10.1007/s00464-002-8837-3. Epub 2002 Jun 27.
This study was conducted to determine if laparoscopic colon surgery has changed the incidence of wound complications after colon resection.
Eighty-three patients were randomized to undergo either laparoscopic (LCR) or open colon resection (OCR) for cancer at our institution as part of a multicenter trial. Data were tabulated from review of the prospective database and physician records.
Thirty-seven patients were randomized to LCR and 46 to OCR. Seven patients in the LCR group were converted to OCR. LCR was performed using a limited midline incision for anastomosis and specimen extraction. Incision length was significantly greater (p <0.001) in the OCR group (19.4 +/- 5.6 cm) compared to the LCR extraction site (6.3 +/- 1.4 cm). Wound infections occurred in 13.5% of patients after LCR (2.7% trocar, 10.8% extraction sites) and in 10.9% of patients after OCR. Over a mean follow-up period of 30.1 +/- 17.8 months, incisional hernias developed in 24.3% of patients after LCR and 17.4% after OCR. In the LCR group, extraction sites accounted for 85.7% of all wound complications.
The extraction site for LCR is associated with a high incidence of complications, comparable to open colectomy. Strategies to alter operative technique should be considered to reduce the incidence of these complications.
本研究旨在确定腹腔镜结肠手术是否改变了结肠切除术后伤口并发症的发生率。
作为一项多中心试验的一部分，83例因癌症在我院接受腹腔镜（LCR）或开放结肠切除术（OCR）的患者被随机分组。数据通过回顾前瞻性数据库和医生记录进行列表整理。
37例患者被随机分配至LCR组，46例至OCR组。LCR组中有7例患者转为OCR手术。LCR手术采用有限的中线切口进行吻合和标本取出。与LCR取出部位（6.3±1.4 cm）相比，OCR组的切口长度明显更长（p<0.001）（19.4±5.6 cm）。LCR术后13.5%的患者发生伤口感染（2.7%为套管针部位，10.8%为取出部位），OCR术后为10.9%。在平均30.1±17.8个月的随访期内，LCR术后24.3%的患者发生切口疝，OCR术后为17.4%。在LCR组中，取出部位占所有伤口并发症的85.7%。
LCR的取出部位并发症发生率较高，与开放结肠切除术相当。应考虑改变手术技术的策略以降低这些并发症的发生率。
