Rosin Danny, Zmora Oded, Hoffman Aviad, Khaikin Marat, Munz Yaron, Zakai Barak Bar, Goldes Yuri, Shabtai Esther L, Shabtai Moshe, Ayalon Amram
The Department of General Surgery & Transplantation Sheba Medical Center, Tel Hashomer.
Harefuah. 2007 Mar;146(3):176-80, 247-8.
Within a decade since laparoscopy was used in cholecystectomy it has become the preferred approach in many abdominal procedures. Laparoscopic colon and rectal surgery has not yet been adopted by the majority of surgeons, due to technical complexity and reservation regarding its oncological safety. As data and experience accumulate, this attitude is gradually changing. We present our experience with laparoscopic surgery of the large bowel over the last ten years.
To assess the short and intermediate term results after laparoscopic colon and rectal surgery, and to summarize the long term results after curative colectomy for malignancy.
Data regarding all patients undergoing laparoscopic colon and rectal surgery was prospectively entered into a computerized database, including demographics, surgical technique and perioperative course. Follow-up information was gathered at outpatient clinic visits, and using telephone interviews in selected cases. Data analysis was performed using a statistical software package.
Over a period of ten years, 350 various laparoscopic colon and rectal procedures were performed, for both benign and malignant conditions. Sixty percent of the operations were for treatment of colorectal cancer. In 14.5% of cases conversion to open laparotomy was required. Post-operative complications included surgical site infection in 17.4%, anastomotic leak in 6.9%, and a mortality rate of 2.8%. Long term follow-up revealed cancer recurrence locally in 2.3% and systemically in 8.2%. Five year survival was 56% after resection of colorectal cancer regardless of the stage, and 63% after resection with curative intent.
The laparoscopic approach to large bowel surgery enables short and long term results comparable with those achieved by open technique, regarding perioperative complication rate and long term oncologic outcome. The advantages of laparoscopy, related to reduced abdominal wall trauma, justify the adoption of this technique as a legitimate alternative to the open approach.
自腹腔镜用于胆囊切除术的十年内，它已成为许多腹部手术的首选方法。由于技术复杂性以及对其肿瘤学安全性的保留态度，大多数外科医生尚未采用腹腔镜结肠和直肠手术。随着数据和经验的积累，这种态度正在逐渐改变。我们介绍过去十年中腹腔镜大肠手术的经验。
评估腹腔镜结肠和直肠手术后的短期和中期结果，并总结根治性结肠切除术后恶性肿瘤的长期结果。
前瞻性地将所有接受腹腔镜结肠和直肠手术患者的数据输入计算机数据库，包括人口统计学、手术技术和围手术期过程。随访信息在门诊就诊时收集，并在选定病例中通过电话访谈收集。使用统计软件包进行数据分析。
在十年期间，共进行了350例各种腹腔镜结肠和直肠手术，包括良性和恶性疾病。60%的手术是用于治疗结直肠癌。14.5%的病例需要转为开腹手术。术后并发症包括手术部位感染17.4%、吻合口漏6.9%，死亡率为2.8%。长期随访显示局部癌症复发率为2.3%，全身复发率为8.2%。无论分期如何，结直肠癌切除术后五年生存率为56%，根治性切除术后为63%。
就围手术期并发症发生率和长期肿瘤学结果而言，腹腔镜大肠手术方法能取得与开放技术相当的短期和长期效果。腹腔镜的优势在于减少腹壁创伤，证明采用该技术作为开放手术的合理替代方法是合理的。
