Kessler H, Hohenberger W
Department of Surgery, University of Erlangen-Nürnberg, Krankenhausstrasse 12, D-91054, Erlangen, Germany.
Surg Endosc. 2006 Jan;20(1):166. doi: 10.1007/s00464-004-6013-7. Epub 2005 Dec 7.
With increasing experience, laparoscopic techniques have been applied even to extended colorectal operations as restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis.
A 36-year-old woman with a 7-year history of ulcerative colitis was transferred for elective surgery 6 weeks after an episode of toxic megacolon treated conservatively. The procedure was performed in modified lithotomy position using six trocars. After initial medial transection of the three main vascular pedicles of the ileocolic and middle colic vessels and the inferior mesenteric artery and vein, the colon was dissected free laterally, from the sigmoid orally toward the ileum. Special consideration was necessary for dissection of the omentum. The rectum was mobilized down to the pelvic floor in two steps, starting at the level of the promontory and the upper rectal stalks. It was transected at the level of the dentate line. Through a Pfannenstiel incision, the bowel was extracted. After transection of the ileum and removal of the specimen, a J-pouch was created. The anastomosis was completed laparoscopically using a double-stapling technique. Finally, a diverting loop ileostomy was created.
A total of 13 patients underwent surgery. The medium age of these patients was 25.5 years (range, 19-57 years). There was no conversion to an open procedure. The median length of hospital stay was 11.5 days (range, 7-107 days). Four patients experienced major complications, including one case each of pouch failure after arterial occlusion, pouch-vaginal fistula, infected hematoma, and intraabdominal abscess formation. There was no postoperative mortality.
For restorative proctocolectomy, laparoscopic techniques proved to be safe and feasible. With further experience, they may have the potential to become an appealing alternative to open surgery.
随着经验的增加，腹腔镜技术甚至已应用于扩大的结直肠手术，如溃疡性结肠炎和家族性腺瘤性息肉病的保留直肠结肠切除术。
一名患有7年溃疡性结肠炎病史的36岁女性，在保守治疗中毒性巨结肠发作6周后转来接受择期手术。手术采用改良截石位，使用6个套管针进行。首先在内侧横断回结肠和中结肠血管以及肠系膜下动脉和静脉的三个主要血管蒂，然后从乙状结肠向回肠方向将结肠外侧游离。在分离大网膜时需要特别注意。分两步将直肠从岬部和直肠上蒂水平向下游离至盆底。在齿状线水平横断直肠。通过Pfannenstiel切口取出肠管。切断回肠并切除标本后，制作一个J形贮袋。使用双吻合器技术在腹腔镜下完成吻合。最后，制作一个转流性回肠造口。
共有13例患者接受了手术。这些患者的平均年龄为25.5岁（范围19 - 57岁）。无一例转为开放手术。中位住院时间为11.5天（范围7 - 107天）。4例患者出现严重并发症，包括动脉闭塞后贮袋功能衰竭、贮袋 - 阴道瘘、感染性血肿和腹腔内脓肿形成各1例。无术后死亡病例。
对于保留直肠结肠切除术，腹腔镜技术被证明是安全可行的。随着经验的进一步积累，它们可能有潜力成为开放手术的一个有吸引力的替代方案。
