Maartense S, Bemelman W A, Gerritsen van der Hoop A, Meijer D W, Gouma D J
Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
Surg Endosc. 2004 Mar;18(3):397-401. doi: 10.1007/s00464-003-9030-z. Epub 2004 Jan 23.
This study was performed to evaluate the (long-term) morbidity associated with hand-assisted laparoscopic surgery (HALS) for various indications.
HALS procedures for various indications were evaluated prospectively from 1995 to 2002. The primary outcome parameters were postsurgical complications and the development of incisional hernias.
Twenty-six splenectomies, 51 hand-assisted laparoscopic donor nephrectomies (HLDN), 34 segmental bowel resections, 29 proctocolectomies, and 10 emergency colectomies were evaluated. A Küstner or Pfannenstiel incision was used for handport placement. Minor complications (i.e., wound complications, urinary tract infection) occurred in 15%, 12%, 26%, 7%, and 33% of the patients after, respectively, splenectomy, HLDN, bowel resection, proctocolectomy, and emergency colectomy. Major complications (i.e., hemorrhage, anastomotic leakage) occurred in 15% and 12% of the patients after, respectively, bowel resection and proctocolectomy. Incisional hernias occurred in six patients (4%), all after a wound complication in the Küstner incision.
HALS is fast, safe, and feasible for various indications, especially HLDN and (procto-)colectomies. Little advantage can be expected when HALS is applied in splenectomy and segmental bowel (sigmoid) resection.
本研究旨在评估手辅助腹腔镜手术（HALS）用于各种适应症时的（长期）发病率。
对1995年至2002年期间各种适应症的HALS手术进行前瞻性评估。主要结局参数为术后并发症和切口疝的发生情况。
评估了26例脾切除术、51例手辅助腹腔镜供体肾切除术（HLDN）、34例节段性肠切除术、29例直肠结肠切除术和10例急诊结肠切除术。采用库斯特纳或Pfannenstiel切口放置手辅助端口。脾切除术、HLDN、肠切除术、直肠结肠切除术和急诊结肠切除术后，分别有15%、12%、26%、7%和33%的患者发生轻微并发症（即伤口并发症、尿路感染）。肠切除术和直肠结肠切除术后，分别有15%和12%的患者发生严重并发症（即出血、吻合口漏）。6例患者（4%）发生切口疝，均在库斯特纳切口出现伤口并发症之后。
HALS对于各种适应症，尤其是HLDN和（直肠）结肠切除术来说，快速、安全且可行。在脾切除术和节段性肠（乙状结肠）切除术中应用HALS时，预期优势不大。
