Ihedioha Ugo, Mackay Graham, Leung Edward, Molloy Richard G, O'Dwyer Patrick J
University Department of Surgery, Western Infirmary, Glasgow, G11 6NT, Scotland.
Surg Endosc. 2008 Mar;22(3):689-92. doi: 10.1007/s00464-007-9462-y.
Laparoscopic colorectal surgery has been reported to have some advantages compared with open surgery. The purpose of this study was to evaluate the incidence of incisional hernias after elective open colorectal resection versus laparoscopic colorectal resection.
The study group consisted of 104 patients who underwent elective colorectal resection or reversal of a Hartmann's procedure between November 2003 and March 2005. Baseline data were prospectively recorded on all patients. All were examined by an independent observer for evidence of incisional hernia after they had reached a minimum follow up of one year.
At a median follow up of 22 (17-26) months, nine patients had died and 95 were reviewed. Of these, 32 underwent laparoscopic resection while 63 had open surgery. Patients were well matched for all baseline characteristics. The median length of the wound in the laparoscopic group was 9 cm (IQR: 8-11 cm) while in the open group it was 20.8 cm (IQR: 17-24 cm). There was no significant difference in incisional hernia rates between the groups (3 vs. 10, p = 0.52) or in those who had symptoms from their hernia (p = 0.773).
Laparoscopic colorectal resection does not appear to reduce incisional hernia rates when compared with open surgery. Large randomised trials are required to confirm these findings.
与开放手术相比,腹腔镜结直肠手术已被报道具有一些优势。本研究的目的是评估择期开放结直肠切除术后与腹腔镜结直肠切除术后切口疝的发生率。
研究组由2003年11月至2005年3月期间接受择期结直肠切除术或哈特曼手术逆转的104例患者组成。前瞻性记录所有患者的基线数据。所有患者在至少随访一年后由一名独立观察者检查切口疝的证据。
在中位随访22(17 - 26)个月时,9例患者死亡,95例接受复查。其中,32例行腹腔镜切除术,63例行开放手术。两组患者的所有基线特征匹配良好。腹腔镜组伤口的中位长度为9 cm(四分位间距:8 - 11 cm),而开放组为20.8 cm(四分位间距:17 - 24 cm)。两组之间的切口疝发生率(3例 vs. 10例,p = 0.52)或有疝相关症状的患者之间(p = 0.773)无显著差异。
与开放手术相比,腹腔镜结直肠切除术似乎并未降低切口疝发生率。需要大型随机试验来证实这些发现。