Larson David W, Cima Robert R, Dozois Eric J, Davies Michael, Piotrowicz Karen, Barnes Sunni A, Wolff Bruce, Pemberton John
Division of Colon and Rectal Surgery, Mayo Clinic College of Medicine, Mayo Clinic Rochester, MN 55905, USA.
Ann Surg. 2006 May;243(5):667-70; discussion 670-2. doi: 10.1097/01.sla.0000216762.83407.d2.
To compare safety and short-term outcomes of 100 laparoscopic ileal pouch-anal anastomosis (IPAA) versus 200 conventional open IPAA patients.
Outcomes of laparoscopic IPAA (LAP-IPAA) have been incompletely characterized. Previous reports are characterized by small numbers of patients and rarely include case-matched or randomized trial methodology. This report describes 100 LAP-IPAA patients case matched to 200 open IPAA patients.
Between 1998 and 2004, 100 consecutive LAP-IPAA patients (75 laparoscopic assisted, 25 hand assisted) were identified and case matched to 200 open IPAA control patients by age, operation, gender, date of operation, and body mass index. Operative and postoperative outcomes at 90 days were compared.
A total of 300 patients (180 female) with a median age of 32 years (range, 17-66 years), and a median body mass index of 23 kg/m (range, 16-34 kg/m) underwent IPAA (100 LAP-IPAA, 200 open IPAA). Diagnosis (chronic ulcerative colitis 97%, familial adenomatous polyposis 3%) and previous operative history were equivalent between groups. One intraoperative complication occurred in each group. Overall, the laparoscopic conversion rate was 6%. Median operative time was longer for the LAP-IPAA group (333 minutes versus 230 minutes, P < 0.0001). LAP-IPAA patients had shorter median time to regular diet (3 versus 5 days), time to ileostomy output (2 versus 3 days), length of stay (4 versus 7 days), and decreased IV narcotic use (all P < 0.05. Postoperative morbidity was equivalent (LAP-IPAA = 33%, open IPAA = 37%), mortality was nil, and readmission rates were equal (LAP-IPAA = 21%, open IPAA = 22%). Reoperation was required in 3% of LAP-IPAA and 6.5% of open IPAA patients (P < 0.2) during the first 3 months.
LAP-IPAA is equivalent to open IPAA in terms of safety and feasibility. In addition, LAP-IPAA provides significant improvements in short-term recovery outcomes.
比较100例腹腔镜回肠储袋肛管吻合术（IPAA）患者与200例传统开放IPAA患者的安全性和短期预后。
腹腔镜IPAA（LAP-IPAA）的预后尚未完全明确。既往报道的病例数较少，且很少采用病例匹配或随机试验方法。本报告描述了100例LAP-IPAA患者与200例开放IPAA患者进行病例匹配的情况。
1998年至2004年间，确定了100例连续的LAP-IPAA患者（75例腹腔镜辅助，25例手辅助），并根据年龄、手术方式、性别、手术日期和体重指数与200例开放IPAA对照患者进行病例匹配。比较90天时的手术和术后预后。
共有300例患者（180例女性）接受了IPAA手术，中位年龄为32岁（范围17-66岁）（LAP-IPAA 100例，开放IPAA 200例）。两组间诊断（慢性溃疡性结肠炎97%，家族性腺瘤性息肉病3%）和既往手术史相当。每组各发生1例术中并发症。总体而言，腹腔镜中转开腹率为6%。LAP-IPAA组的中位手术时间较长（333分钟对230分钟，P<0.0001）。LAP-IPAA患者恢复正常饮食的中位时间较短（3天对5天）、回肠造口排出物出现的时间较短（2天对3天）、住院时间较短（4天对7天），静脉使用麻醉剂减少（均P<0.05）。术后发病率相当（LAP-IPAA=33%，开放IPAA=37%），死亡率为零，再入院率相等（LAP-IPAA=21%，开放IPAA=22%）。在最初3个月内LAP-IPAA患者中有3%需要再次手术，开放IPAA患者中有6.5%需要再次手术（P<0.2）。
LAP-IPAA在安全性和可行性方面与开放IPAA相当。此外，LAP-IPAA在短期恢复预后方面有显著改善。
