Simon Timothy, Orangio Guy, Ambroze Wayne, Schertzer Marion, Armstrong David
Georgia Colon and Rectal Surgical Associates, Atlanta, Georgia 30342, USA.
Dis Colon Rectum. 2003 Oct;46(10):1325-31. doi: 10.1007/s10350-004-6742-7.
The purpose of this study is to discuss indications, technical approach, and morbidity of laparoscopic approaches to major bowel resection in the pediatric/adolescent population with inflammatory bowel disease and familial polyposis.
Retrospective review of laparoscopic-assisted bowel procedures between May 1991 and January 2002 was performed. Laparoscopic-assisted bowel resection is defined as complete intracorporeal mobilization and devascularization of a segment of colon or rectum. The indications for extracorporeal vs. intracorporeal anastomosis will be discussed. Clinically unstable, septic, or massively bleeding patients were not candidates for this technique. The decision to attempt the laparoscopic approach was based on the experience of the consulting surgeon. There were 31 patients, including 14 females. Five patients had undergone prior surgery. Twenty-nine patients had inflammatory bowel disease, one had familial polyposis, and one had a cavernous hemangioma. We included all pediatric/adolescent patients in our practice undergoing laparoscopic resection.
Twenty-nine patients had 33 laparoscopic operations, including proctocolectomy with ileal pouch-anal anastomosis (n = 14), proctocolectomy with ileostomy (n = 3), ileocolectomy with ileocolic anastomosis (n = 13), and small-bowel obstruction (n = 1). Average operating time was 158 (range, 30-400) minutes, with average blood loss of 159 ml. Average wound length was 4.9 cm. The complication rate was 16 percent (n = 5), with one anastomotic leak. The rate of conversion to open operations was 5.8 percent. Liquid diet was begun on Day 3, and the average length of stay was 5.9 days.
Major laparoscopic bowel surgery can be performed safely in the pediatric/adolescent population, with reasonable operative times, low conversion to open operations, and low morbidity.
本研究旨在探讨在患有炎症性肠病和家族性息肉病的儿科/青少年人群中，腹腔镜下进行大肠切除术的适应症、技术方法及发病率。
对1991年5月至2002年1月间的腹腔镜辅助肠道手术进行回顾性研究。腹腔镜辅助肠道切除术定义为结肠或直肠某段的完全体内游离及血管离断。将讨论体外吻合与体内吻合的适应症。临床不稳定、感染或大量出血的患者不适合该技术。尝试腹腔镜手术的决定基于会诊外科医生的经验。共有31例患者，包括14名女性。5例患者曾接受过先前手术。29例患者患有炎症性肠病，1例患有家族性息肉病，1例患有海绵状血管瘤。我们纳入了所有在我们科室接受腹腔镜切除术的儿科/青少年患者。
29例患者接受了33次腹腔镜手术，包括回肠储袋肛管吻合术的全直肠结肠切除术（n = 14）、回肠造口术的全直肠结肠切除术（n = 3）、回结肠吻合术的回结肠切除术（n = 13）以及小肠梗阻手术（n = 1）。平均手术时间为158（范围30 - 400）分钟，平均失血量为159毫升。平均伤口长度为4.9厘米。并发症发生率为16%（n = 5），其中1例吻合口漏。转为开放手术的比例为5.8%。术后第3天开始进流食，平均住院时间为5.9天。
在儿科/青少年人群中，腹腔镜下的大肠大手术可以安全进行，手术时间合理，转为开放手术的比例低，发病率也低。
