Montgomery Jeffrey S, Johnston William K, Wolf J Stuart
Michigan Urology Center, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
J Urol. 2005 Dec;174(6):2226-30. doi: 10.1097/01.ju.0000181805.30826.fa.
Hand assisted laparoscopic surgery (HALS) provides benefits similar to standard laparoscopy but generally requires a larger incision. We assessed the nature of and risk factors for incisional complications after HALS.
All patients who underwent HALS at our institution from February 1997 through December 2003 were included in a prospective and retrospective review to assess postoperative wound complications. Literature regarding wound complications associated with open surgery and standard laparoscopy was reviewed.
A total of 424 consecutive procedures performed on 422 patients were evaluated. Postoperative HALS incision site complications included 29 infections (6.8%), 15 hernias (3.5%) and 2 dehiscences (0.5%). Multivariate logistic regression models revealed that HALS incision site hernias were associated with current or past tobacco smoking (6.0%, p = 0.04), with a trend toward significance for diabetes mellitus (14%, p = 0.07), male gender (5.3%, p = 0.08) and renal failure (16%, p = 0.08). HALS incision site infections were associated with omission of perioperative antibiotics (13%, p = 0.007), obesity (12%, p = 0.03) and increased operative time (252 vs 222 minutes in patients with and without infection, respectively, p = 0.001).
Our findings suggest that wound infections and hernias occur less frequently with HALS than with open surgery, but more often than with standard laparoscopy. Certain patient comorbidities (eg obesity), modifiable risk factors (eg smoking status) and procedural variables (eg omission of perioperative antibiotics or length of procedure) may adversely influence HALS wound complications. This information can be used to decide between HALS and standard laparoscopic approaches in particular patients.
手辅助腹腔镜手术（HALS）具有与标准腹腔镜手术相似的益处，但通常需要更大的切口。我们评估了HALS术后切口并发症的性质及危险因素。
1997年2月至2003年12月在我院接受HALS的所有患者纳入前瞻性和回顾性研究，以评估术后伤口并发症。回顾了与开放手术和标准腹腔镜手术相关的伤口并发症的文献。
对422例患者进行的424例连续手术进行了评估。HALS术后切口部位并发症包括29例感染（6.8%）、15例疝（3.5%）和2例切口裂开（0.5%）。多因素逻辑回归模型显示，HALS切口部位疝与当前或既往吸烟有关（6.0%，p = 0.04），糖尿病有显著趋势（14%，p = 0.07），男性（5.3%，p = 0.08）和肾衰竭（16%，p = 0.08）。HALS切口部位感染与围手术期抗生素遗漏有关（13%，p = 0.007）、肥胖（12%，p = 0.03）和手术时间延长有关（有感染患者与无感染患者分别为252分钟和222分钟，p = 0.001）。
我们的研究结果表明，HALS术后伤口感染和疝的发生率低于开放手术，但高于标准腹腔镜手术。某些患者合并症（如肥胖）、可改变的危险因素（如吸烟状况）和手术变量（如围手术期抗生素遗漏或手术时间）可能对HALS伤口并发症产生不利影响。这些信息可用于特定患者HALS与标准腹腔镜手术方法的选择。
