Rosen Michael J, Cobb William S, Kercher Kent W, Heniford B Todd
Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
J Gastrointest Surg. 2006 Jun;10(6):895-900. doi: 10.1016/j.gassur.2005.11.008.
Open colostomy reversal carries significant rates of wound infection, anastomotic leak, and incisional hernia which often limit its acceptance. We hypothesized that the laparoscopic approach to the restoration of intestinal continuity may result in lower perioperative morbidity and faster postoperative recovery. Twenty-two cases of laparoscopic colostomy reversals performed at a single institution were identified and compared to 22 randomly selected open colostomy closures performed during the same time period. Patients were compared based on demographics, previous indications for colostomy procedures, and perioperative outcomes. A total of 152 patients underwent reversal of left-sided colostomies during the study period. The laparoscopic approach was successful in 20 of 22 cases; there were 2 conversions to open (9%) secondary to inability to adequately mobilize the rectal stump. The laparoscopic and open groups were comparable based on mean age (54 years versus 49 years; P = 0.23), BMI (26 kg/m(2) versus 27 kg/m(2); P = 0.66), gender (9% males versus 13% males; P = 0.23), ASA Class (2.6 versus 2.3; P = 0.07), and history of previous intra-abdominal sepsis (17 versus 16 cases). Operative times were similar (158 versus 189 minutes; P = 0.16), and estimated blood loss was significantly less in the laparoscopic group (113 versus 270 ml; P = 0.01). No intraoperative complications occurred in the laparoscopic group and two enterotomies occurred in the open group. The laparoscopic group had earlier passage of flatus (3.5 versus 5.0 days; P = 0.001) and shorter hospitalization (4.2 versus 7.3 days; P = 0.001). Perioperative complications occurred in 3 (14%) laparoscopic and 13 (59%) open cases (P = 0.01). There was no mortality in this series. The laparoscopic approach can be safely used in the restoration of intestinal continuity. It results in a decreased perioperative morbidity and faster recovery, and it offers distinct advantages over the open approach to colostomy reversal.
开放式结肠造口回纳术的伤口感染、吻合口漏及切口疝发生率较高，这常常限制了其应用。我们推测，采用腹腔镜方法恢复肠道连续性可能会降低围手术期发病率，并加快术后恢复。我们确定了在同一机构进行的22例腹腔镜结肠造口回纳术病例，并与同期随机选取的22例开放式结肠造口关闭术病例进行比较。根据人口统计学、结肠造口术的既往指征及围手术期结果对患者进行比较。在研究期间，共有152例患者接受了左侧结肠造口回纳术。22例中有20例腹腔镜手术成功；2例因无法充分游离直肠残端而转为开放手术（9%）。腹腔镜组和开放手术组在平均年龄（54岁对49岁；P = 0.23）、体重指数（26kg/m²对27kg/m²；P = 0.66）、性别（男性9%对13%；P = 0.23）、美国麻醉医师协会分级（2.6对2.3；P = 0.07）及既往腹腔内感染病史（17例对16例）方面具有可比性。手术时间相似（158分钟对189分钟；P = 0.16），腹腔镜组估计失血量明显较少（113ml对270ml；P = 0.01）。腹腔镜组未发生术中并发症，开放手术组发生了2例肠切开。腹腔镜组排气时间更早（3.5天对5.0天；P = 0.001），住院时间更短（4.2天对7.3天；P = 0.001）。围手术期并发症在3例（14%）腹腔镜手术病例和13例（59%）开放手术病例中发生（P = 0.01）。本系列无死亡病例。腹腔镜方法可安全用于恢复肠道连续性。它可降低围手术期发病率并加快恢复，与开放式结肠造口回纳术相比具有明显优势。
