Bleier J I, Moon Victor, Feingold Daniel, Whelan Richard L, Arnell Tracy, Sonoda Toyooki, Milsom J W, Lee S W
Section of Colon & Rectal Surgery, New York Presbyterian Hospital/Weill Medical College of Cornell University, New York, NY, USA.
Surg Endosc. 2008 Mar;22(3):646-9. doi: 10.1007/s00464-007-9429-z.
Iatrogenic perforation of the colon during elective colonoscopy is a rare but serious complication. Treatment using laparoscopic methods is a novel approach, only described in the recent literature. We hypothesized that laparoscopic treatment of iatrogenic colon perforation would result in equal therapeutic efficacy, less perioperative morbidity, smaller incisions and decreased length of stay, and an overall better short-term outcome compared to open methods.
We reviewed our prospectively collected patient database from July 2001 to July 2005 and compared the intraoperative data and postoperative outcomes of patients who underwent laparoscopic primary repair versus those who had open primary repairs of iatrogenically perforated large bowel.
The laparoscopic (mean age 70 years; range 20-91 years; 18 percent male) and open (mean age 68 years; range 36-87 years; 43 percent male) groups were similar with regard to age. Overall, patients who underwent laparoscopic (n = 11) versus open (n = 7) repair had comparable operative (OR) times (mean 104 minutes, range 60-150 minutes versus mean 98 minutes, range 40-130 minutes, p = 0.04), shorter length of stay [LOS, (5.1 +/- 1.7 days versus 9.2 +/- 3.1 days, p = 0.01)], fewer complications (two versus five, p = 0.02) and shorter incision length (16 +/- 14.7 mm versus 163 +/- 54.4 mm, p = 0.001).
A laparoscopic approach to iatrogenic colon perforation results in decreased morbidity, decreased length of stay, and a shorter incision length compared to an open method. In those cases where it is feasible and the surgical skills exist, a laparoscopic attempt at colon repair should probably be the initial clinical approach.
择期结肠镜检查期间发生的医源性结肠穿孔是一种罕见但严重的并发症。采用腹腔镜方法进行治疗是一种新的手段，仅在近期文献中有描述。我们推测，与开放手术方法相比，腹腔镜治疗医源性结肠穿孔将产生同等的治疗效果、更低的围手术期发病率、更小的切口以及更短的住院时间，并且总体短期预后更佳。
我们回顾了2001年7月至2005年7月前瞻性收集的患者数据库，并比较了接受腹腔镜一期修复与接受开放性一期修复医源性大肠穿孔患者的术中数据及术后结果。
腹腔镜组（平均年龄70岁；范围20 - 91岁；男性占18%）和开放手术组（平均年龄68岁；范围36 - 87岁；男性占43%）在年龄方面相似。总体而言，接受腹腔镜修复（n = 11）与开放手术修复（n = 7）的患者手术时间相当（平均104分钟，范围60 - 150分钟对平均98分钟，范围40 - 130分钟，p = 0.04），住院时间更短[住院时间，（5.1±1.7天对9.2±3.1天，p = 0.01）]，并发症更少（2例对5例，p = 0.02），切口长度更短（16±14.7毫米对163±54.4毫米，p = 0.001）。
与开放手术方法相比，腹腔镜治疗医源性结肠穿孔可降低发病率、缩短住院时间并减小切口长度。在可行且具备手术技能的情况下，腹腔镜下尝试结肠修复可能应作为初始临床方法。
