Casillas Sergio, Delaney Conor P, Senagore Anthony J, Brady Karen, Fazio Victor W
Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Dis Colon Rectum. 2004 Oct;47(10):1680-5. doi: 10.1007/s10350-004-0692-4.
Conversion during laparoscopic colectomy varies in frequency according to the surgeon's experience and case selection. However, there remains concern that conversion is associated with increased morbidity and higher hospital costs.
From January 1999 to August 2002, 430 laparoscopic colectomies were performed by two surgeons, with 51 (12 percent) cases converted to open surgery. Converted cases were matched for operation and age to 51 open cases performed mostly by other colorectal surgeons from our department. Data collected included gender, American Society of Anesthesiology score, operative indication, resection type, operative stage at conversion, in-hospital complications, direct hospital costs, unexpected readmission within 30 days, and mortality.
There were no significant differences between the groups for age (converted, 55 +/- 19; open, 62 +/- 16), male:female ratio (converted, 17:34; open, 23:28), or American Society of Anesthesiology score distribution. Indications for surgery were neoplasia (converted, 16; open, 31); diverticular disease (converted, 21; open, 13); Crohn's disease (converted, 12; open, 5); and other disease (converted, 2; open, 2). Operative times were similar (converted, 150 + 56 minutes; open, 132 +/- 48 minutes). Conversions occurred before defining the major vascular pedicle/ureter (50 percent), in relation to intracorporeal vascular ligation (15 percent), or during bowel transection or presacral dissection (35 percent). Specific indications for conversion were technical (41 percent), followed by adhesions (33 percent), phlegmon or abscess (23 percent), bleeding (6 percent), and failure to identify the ureter (6 percent). Median hospital stay was five days for both groups. In-hospital complications (converted 11.6 percent; open 8 percent), 30-day readmission rate (converted 13 percent vs. open 8 percent), and direct costs were similar between groups. There were no mortalities.
Conversion of a laparoscopic colectomy does not result in inappropriately prolonged operative times, increased morbidity or length of stay, increased direct costs, or unexpected readmissions compared with similarly complex laparotomies. A policy of commencing most cases suitable for a laparoscopic approach laparoscopically offers patients the benefits of a laparoscopic colectomy without adversely affecting perioperative risks.
腹腔镜结肠切除术中转开腹的频率因外科医生的经验和病例选择而异。然而，人们仍然担心中转开腹与发病率增加和更高的医院成本相关。
1999年1月至2002年8月，两位外科医生共进行了430例腹腔镜结肠切除术，其中51例（12%）中转开腹。将中转开腹的病例与51例主要由本部门其他结直肠外科医生进行的开腹手术病例按手术和年龄进行匹配。收集的数据包括性别、美国麻醉医师协会评分、手术指征、切除类型、中转时的手术分期、住院并发症、直接医院成本、30天内意外再入院情况和死亡率。
两组在年龄（中转开腹组，55±19岁；开腹组，62±16岁）、男女比例（中转开腹组，17:34；开腹组，23:28）或美国麻醉医师协会评分分布方面无显著差异。手术指征为肿瘤（中转开腹组16例；开腹组31例）；憩室病（中转开腹组21例；开腹组13例）；克罗恩病（中转开腹组12例；开腹组5例）；以及其他疾病（中转开腹组2例；开腹组2例）。手术时间相似（中转开腹组，150±56分钟；开腹组，132±48分钟）。中转开腹发生在确定主要血管蒂/输尿管之前（50%）、与体内血管结扎有关（15%）或在肠切除或骶前解剖期间（35%）。中转开腹的具体指征为技术问题（41%），其次是粘连（33%）、蜂窝织炎或脓肿（23%）、出血（6%）和未能识别输尿管（6%）。两组的中位住院时间均为5天。两组的住院并发症（中转开腹组11.6%；开腹组8%）、30天再入院率（中转开腹组13%对开腹组8%）和直接成本相似。无死亡病例。
与同样复杂的开腹手术相比，腹腔镜结肠切除术中转开腹不会导致手术时间延长不当、发病率或住院时间增加、直接成本增加或意外再入院。对于大多数适合腹腔镜手术的病例，采用腹腔镜手术开始的策略可为患者提供腹腔镜结肠切除术的益处，而不会对围手术期风险产生不利影响。
