Plocek Margaret D, Geisler Daniel P, Glennon Edward J, Kondylis Phillip, Reilly John C
Section of Colorectal Surgery, St. Vincent Health System, Erie, PA, USA.
Am J Surg. 2005 Dec;190(6):882-5. doi: 10.1016/j.amjsurg.2005.08.014.
Major comorbidities are recognized risk factors in colorectal surgery. We examine here the feasibility and safety of laparoscopic colorectal surgery (LC) in the complicated, high-risk patient.
From July 2003 to October 2004, 107 consecutive patients undergoing LC were prospectively studied. Complicated patients were defined as age >80 years, body mass index (BMI) >30, and/or American Society of Anesthesiology level III or IV. A group of case-matched controls undergoing open surgery (OC) during a similar time period were retrospectively reviewed. The 2 groups were compared and assessed for major and minor morbidity and mortality.
Overall morbidity was higher in the OC group 52% versus 26%. Minor complications compared at 31% OC versus 9% LC and major at 21% and 17%, respectively. With LC, advancement to discharge was more rapid and discharge home more likely than to a care facility.
With proper patient selection and laparoscopic experience, LC can be performed in the complicated patient without undue morbidity and mortality.
主要合并症是结直肠手术中公认的风险因素。我们在此研究在复杂的高危患者中进行腹腔镜结直肠手术（LC）的可行性和安全性。
2003年7月至2004年10月，对107例连续接受LC的患者进行前瞻性研究。复杂患者定义为年龄>80岁、体重指数（BMI）>30和/或美国麻醉医师协会分级为III或IV级。回顾性分析一组在相似时间段内接受开放手术（OC）的病例匹配对照。比较两组的主要和次要发病率及死亡率。
OC组的总体发病率较高，为52%，而LC组为26%。次要并发症方面，OC组为31%，LC组为9%；主要并发症方面，分别为21%和17%。采用LC时，患者出院进程更快，更有可能出院回家而非前往护理机构。
通过适当的患者选择和腹腔镜手术经验，可在复杂患者中进行LC，且不会导致过高的发病率和死亡率。
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