Bergamaschi Roberto, Pessaux Patrick, Arnaud Jean-Pierre
Deparment of Surgery, Angers University Hospital, Angers, France.
Dis Colon Rectum. 2003 Aug;46(8):1129-33. doi: 10.1007/s10350-004-7292-8.
The purpose of this study was to compare open with laparoscopic ileocolic resection in selected patients with refractory Crohn's disease confined to terminal ileum and cecum in terms of small-bowel obstruction and recurrence rates at a follow-up of five years.
Thirty-nine patients who underwent laparoscopic ileocolic resection during a four-year period were compared with 53 patients who had previously undergone open ileocolic resection by the same surgeons at the same institution. Small-bowel obstruction was any clinical evidence of obstruction requiring hospital admission, regardless of recurrent disease or the need for surgery. Recurrence was defined as histologically proven Crohn's disease requiring reoperation and assessed by the actuarial method. Data were presented as medians and ranges and analyzed with Fisher's exact test, Student's t-test, Wilcoxon's rank-sum test, and log-rank test.
Open ileocolic resection and laparoscopic ileocolic resection patients were well matched for age, gender, body mass index, American Society of Anesthesiologists grade, smoking, length of time from diagnosis to index operation, site of disease, preoperative medical treatment, previous abdominal surgery, indications for surgery, anastomosis configuration, microscopical involvement of resection margins, and postoperative complications (9.4 vs. 10.2 percent). Operating time was longer for laparoscopic ileocolic resection patients (105 (60-120) vs. 185 (130-210) min, P < 0.001). Hospital stay was shorter for laparoscopic ileocolic resection patients (11.2 (5-20) vs. 5.6 (3-11) days, P < 0.001). At five-year follow-up, 90.5 percent of open ileocolic resection patients and 92.3 percent of laparoscopic ileocolic resection patients were available. Five-year small-bowel obstruction rates were 35.4 and 11.1 percent, respectively, in open ileocolic resection and laparoscopic ileocolic resection patients (17 vs. 4 patients, P = 0.02). Five-year-recurrence rates were 29.1 (14/48) and 27.7 percent (10/36). Median time to recurrence was 48 and 56 months, respectively, following open ileocolic resection and laparoscopic ileocolic resection (P = 0.9104).
When compared with open ileocolic resection, laparoscopic ileocolic resection led to lower five-year small-bowel obstruction rates in selected patients with ileocecal Crohn's disease. Five-year recurrence rates did not differ.
本研究旨在比较开放手术与腹腔镜下回结肠切除术治疗局限于回肠末端和盲肠的难治性克罗恩病患者的小肠梗阻情况及五年随访期内的复发率。
将在四年期间接受腹腔镜下回结肠切除术的39例患者与同一机构中由相同外科医生实施过开放回结肠切除术的53例患者进行比较。小肠梗阻是指任何需要住院治疗的梗阻临床证据，无论是否为复发性疾病或是否需要手术。复发定义为经组织学证实的克罗恩病需要再次手术，并采用精算方法进行评估。数据以中位数和范围表示，并采用Fisher精确检验、Student t检验、Wilcoxon秩和检验及对数秩检验进行分析。
开放回结肠切除术和腹腔镜下回结肠切除术患者在年龄、性别、体重指数、美国麻醉医师协会分级、吸烟情况、从诊断到首次手术的时间、疾病部位、术前药物治疗、既往腹部手术史、手术指征、吻合方式、切除边缘的显微镜下累及情况及术后并发症方面（9.4%对10.2%）匹配良好。腹腔镜下回结肠切除术患者的手术时间更长（105（60 - 120）分钟对185（130 - 210）分钟，P < 0.001）。腹腔镜下回结肠切除术患者的住院时间更短（11.2（5 - 20）天对5.6（3 - 11）天，P < 0.001）。在五年随访期内，90.5%的开放回结肠切除术患者和92.3%的腹腔镜下回结肠切除术患者可进行评估。开放回结肠切除术和腹腔镜下回结肠切除术患者的五年小肠梗阻率分别为35.4%和11.1%（17例对4例，P = 0.02）。五年复发率分别为29.1%（14/48）和27.7%（10/36）。开放回结肠切除术和腹腔镜下回结肠切除术后复发的中位时间分别为48个月和56个月（P = 0.9104）。
与开放回结肠切除术相比，腹腔镜下回结肠切除术可使选定的回盲部克罗恩病患者五年小肠梗阻率降低。五年复发率无差异。
