腹腔镜全结肠切除术：一段演进历程。

Laparoscopic total colectomy: an evolutionary experience.

作者信息

Boushey Robin P, Marcello Peter W, Martel Guillaume, Rusin Lawrence C, Roberts Patricia L, Schoetz David J

机构信息

Department of Colon and Rectal Surgery, Lahey Clinic, 41 Mall Road, Burlington, Massachusetts 01805, USA.

出版信息

Dis Colon Rectum. 2007 Oct;50(10):1512-9. doi: 10.1007/s10350-007-0304-8.

DOI:10.1007/s10350-007-0304-8

PMID:17762963

Abstract

PURPOSE

Laparoscopic total abdominal colectomy and total proctocolectomy are technically challenging operations. Advances in minimally invasive techniques, including sleeveless hand-assist devices, may influence performance of these procedures. This study was designed to evaluate the results of laparoscopic total colectomy and to compare the hand-assisted approach with straight laparoscopy.

METHODS

Sequential patients undergoing hand-assisted and straight laparoscopic total abdominal colectomy and total proctocolectomy from 1997 to 2004 were identified from a single institution prospective database involving four colorectal surgeons, of which three had limited laparoscopic experience. Patient characteristics, perioperative parameters, and outcomes were assessed.

RESULTS

A total of 130 patients were analyzed. Sixty-nine patients underwent total abdominal colectomy (hand-assisted 17 vs. straight laparoscopic 52), and 61 underwent total proctocolectomy (hand-assisted 28 vs. straight laparoscopic 33). For both total abdominal colectomy and total proctocolectomy, the hand-assisted and straight laparoscopic groups were well matched. Although no differences were observed in operative blood loss and intraoperative complications, hand assistance resulted in fewer overall conversions to open (1/45 (2.2 percent) vs. 6/85 (7.1 percent); P < 0.01), with no conversions in the total abdominal colectomy group (0 vs. 9.6 percent; P = 0.05). There was a trend toward reduced operative time with hand assistance, and nonlaparoscopic staff surgeons performed a greater proportion of the hand-assisted cases (22.2 vs. 10.6 percent; P < 0.05).

CONCLUSIONS

Laparoscopic total colectomy is technically feasible and safe. With a significant reduction in conversions and a greater proportion of cases performed by nonlaparoscopic surgeons, there was an evolutionary shift to a hand-assisted technique. A hand-assisted approach may be a useful alternative to a straight laparoscopic approach for this technically challenging operation.

摘要

目的

腹腔镜全腹结肠切除术和全直肠结肠切除术在技术上具有挑战性。包括无袖手辅助装置在内的微创技术的进步可能会影响这些手术的实施。本研究旨在评估腹腔镜全结肠切除术的结果，并比较手辅助方法与直接腹腔镜手术。

方法

从一个涉及四位结直肠外科医生的单一机构前瞻性数据库中识别出1997年至2004年接受手辅助和直接腹腔镜全腹结肠切除术及全直肠结肠切除术的连续患者，其中三位医生腹腔镜经验有限。评估患者特征、围手术期参数和结果。

结果

共分析了130例患者。69例患者接受了全腹结肠切除术（手辅助17例 vs. 直接腹腔镜52例），61例接受了全直肠结肠切除术（手辅助28例 vs. 直接腹腔镜33例）。对于全腹结肠切除术和全直肠结肠切除术，手辅助组和直接腹腔镜组匹配良好。虽然在术中失血和术中并发症方面未观察到差异，但手辅助导致总体中转开腹的情况更少（1/45（2.2%） vs. 6/85（7.1%）；P < 0.01），全腹结肠切除术组无中转开腹情况（0 vs. 9.6%；P = 0.05）。手辅助有缩短手术时间的趋势，非腹腔镜 staff 外科医生进行的手辅助病例比例更高（22.2% vs. 10.6%；P < 0.05）。