Maartense Stefan, Dunker Michalda S, Slors J Frederick, Cuesta Miguel A, Gouma Dirk J, van Deventer Sander J, van Bodegraven Ad A, Bemelman Willem A
Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Ann Surg. 2004 Dec;240(6):984-91; discussion 991-2. doi: 10.1097/01.sla.0000145923.03130.1c.
The aim of the study was to evaluate postoperative recovery after hand-assisted laparoscopic or open restorative proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis in a randomized controlled trial.
Sixty patients were randomized for hand-assisted laparoscopic (n = 30) or open surgery (n = 30). Primary outcome parameter was postoperative recovery in the 3 months after surgery, measured by quality of life questionnaires (SF-36 and GIQLI). Secondary parameters were postoperative morphine requirement and surgical parameters, viz. operating time, morbidity, hospital stay, and costs.
There was no difference between the 2 procedures in quality of life assessment in the 3 months after surgery. There was a significant decline in quality of life on all scales of the SF-36 (P < 0.001) and total GIQLI score (P < 0.001) in the first 2 weeks in both groups (no significant difference between the groups). Quality of life returned to baseline levels after 4 weeks. Operating times were longer in the laparoscopic group compared with the open group (210 and 133 minutes, respectively; P < 0.001). No significant differences were found in morphine requirement. Neither morbidity nor postoperative hospital stay differed between the laparoscopic and open group (20% versus 17%, in 10 versus 11 days, respectively). Median overall costs were 16.728 for the hand-assisted laparoscopic procedure and 13.406 for the open procedure (P = 0.095).
Recovery measured using quality of life questionnaires is comparable for hand-assisted laparoscopic or open restorative proctocolectomy with ileal pouch anal anastomosis. The laparoscopic approach is as safe, but more costly than the open procedure.
本研究旨在通过一项随机对照试验，评估手辅助腹腔镜或开放性直肠结肠切除回肠储袋肛管吻合术治疗溃疡性结肠炎和家族性腺瘤性息肉病后的术后恢复情况。
60例患者被随机分为手辅助腹腔镜手术组（n = 30）和开放手术组（n = 30）。主要结局参数是术后3个月的术后恢复情况，通过生活质量问卷（SF - 36和GIQLI）进行测量。次要参数是术后吗啡需求量和手术参数，即手术时间、发病率、住院时间和费用。
术后3个月，两种手术方式在生活质量评估方面无差异。两组在术后前2周，SF - 36所有量表（P < 0.001）和GIQLI总分（P < 0.001）的生活质量均显著下降（两组间无显著差异）。4周后生活质量恢复至基线水平。腹腔镜组的手术时间比开放组更长（分别为210分钟和133分钟；P < 0.001）。吗啡需求量方面未发现显著差异。腹腔镜组和开放组在发病率和术后住院时间上均无差异（分别为20%对17%，住院10天对11天）。手辅助腹腔镜手术的总体费用中位数为16728，开放手术为13406（P = 0.095）。
使用生活质量问卷测量的手辅助腹腔镜或开放性直肠结肠切除回肠储袋肛管吻合术的恢复情况具有可比性。腹腔镜手术方式同样安全，但比开放手术费用更高。
