Kehlet H, Kennedy R H
Section of Surgical Pathophysiology, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark.
Colorectal Dis. 2006 Jul;8(6):514-7. doi: 10.1111/j.1463-1318.2006.00955.x.
Laparoscopic colonic resection may facilitate early postoperative recovery due to reduced surgical stress, pain and ileus. However, large randomised studies have only shown marginal improvements in outcome compared with open surgery, reporting a median hospital stay of about 5-7 days. Concomitant with these developments multimodal rehabilitation, which involves a revision of general postoperative care principles, improved pain relief with epidural analgesia and early oral nutrition and mobilization, has demonstrated greater improvements in recovery after open surgery, resulting in a median hospital stay of about 2-4 days. Recent single centre, randomised studies where laparoscopic and open colonic resection are combined with multimodal rehabilitation have not resolved the debate regarding which is the optimal operative technique. Therefore, new strategies are required to integrate laparoscopy with multimodal rehabilitation in order to establish its advantages, cost effectiveness and indications in specific groups of patients or colorectal procedures, thus justifying widespread application of the laparoscopic technique.
腹腔镜结肠切除术可能因手术应激、疼痛和肠梗阻减轻而有助于术后早期恢复。然而，大型随机研究表明，与开放手术相比，其在结局方面仅显示出微小改善，报告的中位住院时间约为5 - 7天。伴随着这些进展，多模式康复（包括对一般术后护理原则的修订、采用硬膜外镇痛改善疼痛缓解以及早期口服营养和活动）已证明在开放手术后的恢复方面有更大改善，中位住院时间约为2 - 4天。近期将腹腔镜和开放结肠切除术与多模式康复相结合的单中心随机研究尚未解决关于哪种手术技术最佳的争论。因此，需要新的策略将腹腔镜检查与多模式康复相结合，以确定其在特定患者群体或结直肠手术中的优势、成本效益和适应症，从而证明腹腔镜技术的广泛应用是合理的。
