Basse L, Madsen J L, Billesbølle P, Bardram L, Kehlet H
Department of Surgical Gastroenterology, Copenhagen University Hospital, Hvidovre, Denmark.
Surg Endosc. 2003 Dec;17(12):1919-22. doi: 10.1007/s00464-003-9013-0. Epub 2003 Oct 28.
Multimodal rehabilitation with epidural analgesia, early oral nutrition and mobilization, and laxative use has decreased the duration of ileus after colonic surgery to about 2 days, as compared with the usual 3 to 5 days of rehabilitation required after open surgery and the slightly shorter time required with laparoscopic surgery. Gastrointestinal transit after colonic resection with laparoscopy or laparotomy was assessed.
In this study, 32 patients randomized to laparoscopic or open colonic resection received 4 MBq of 111indium diethylenetriamine pentaacetic acid, a tracer, at the end of surgery. Images of the abdomen were obtained 24 and 48 h postoperatively. An opaque abdominal dressing blinded care personnel and patients to the procedure.
Defecation occurred on median day 2 postoperatively in both groups. At 48 h postoperatively, 53% of the tracer was excreted by patients in the laparoscopic group, as compared with 26% in the open group ( p > 0.05).
Postoperative ileus and gastrointestinal transit normalized within 48 h after colonic resection in the patients who received multimodal rehabilitation. No significant difference was observed between the patients who underwent the laparoscopic procedure and those who underwent the open procedure.
与开放手术后通常需要3至5天的康复时间以及腹腔镜手术后所需的稍短时间相比，采用硬膜外镇痛、早期口服营养和活动以及使用泻药的多模式康复已将结肠手术后肠梗阻的持续时间缩短至约2天。对腹腔镜或开腹结肠切除术后的胃肠运输情况进行了评估。
在本研究中，32例随机接受腹腔镜或开放结肠切除术的患者在手术结束时接受了4MBq的111铟二乙三胺五乙酸（一种示踪剂）。术后24小时和48小时获取腹部图像。使用不透明的腹部敷料使护理人员和患者对该操作不知情。
两组患者术后排便的中位时间均为第2天。术后48小时，腹腔镜组患者排出了53%的示踪剂，而开放组为26%（p>0.05）。
接受多模式康复的患者在结肠切除术后48小时内肠梗阻和胃肠运输恢复正常。接受腹腔镜手术的患者与接受开放手术的患者之间未观察到显著差异。
