Scala A, Huang A, Dowson H M P, Rockall T A
Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, Surrey, UK.
Colorectal Dis. 2007 Oct;9(8):701-5. doi: 10.1111/j.1463-1318.2006.01198.x.
Laparoscopic surgery is increasingly being performed for benign and malignant colorectal disease. This study examines the short-term results in a consecutive series of laparoscopic colorectal procedures performed over 2 years.
A prospective database was established for all elective patients undergoing laparoscopic colorectal surgery by one surgeon. The main outcome measures assessed were operative duration, conversion rate, length of hospital stay, morbidity and mortality and lymph node harvest.
Two hundred and thirty-one consecutive patients were referred for elective colorectal surgery, with 18 patients excluded from laparoscopic surgery. Thirteen patients had nonresective laparoscopic colorectal procedures for endometriosis and have been excluded from the series. Of 200 patients who underwent a laparoscopic colorectal procedure, 114 (57%) were female, the median age was 67 years (inter-quartile range (IQR) 57-76), and there were 116 malignancies. The most common operations were anterior resection and sigmoid colectomy (n = 82), right hemicolectomy (n = 62) and left hemicolectomy (n = 12). The median operating time was 120 min (IQR 90-150) and 10 patients (5%) required conversion to open surgery. The median lymph node harvest in malignancies was 21 nodes (IQR 15-30) and no positive resection margins were found. There were two deaths and 29 significant complications (14.5%), with seven patients requiring re-operations because of postoperative complications. The median postoperative hospital stay was 4 days (IQR 3-6) and 13 patients (6.5%) were re-admitted within 30 days of hospital discharge.
Laparoscopic colorectal surgery is possible for most benign and malignant conditions, with low conversion and complication rates, as well as short hospital stay.
腹腔镜手术在良性和恶性结直肠疾病的治疗中应用越来越广泛。本研究对连续2年进行的一系列腹腔镜结直肠手术的短期结果进行了分析。
为一位外科医生实施的所有择期腹腔镜结直肠手术患者建立了前瞻性数据库。评估的主要指标包括手术时间、中转率、住院时间、发病率、死亡率和淋巴结清扫数量。
连续231例患者被转诊进行择期结直肠手术，其中18例患者被排除在腹腔镜手术之外。13例因子宫内膜异位症接受非切除性腹腔镜结直肠手术的患者也被排除在本系列研究之外。在200例接受腹腔镜结直肠手术的患者中，114例（57%）为女性，中位年龄为67岁（四分位间距（IQR）57 - 76岁），有116例恶性肿瘤患者。最常见的手术是前切除术和乙状结肠切除术（n = 82）、右半结肠切除术（n = 62）和左半结肠切除术（n = 12）。中位手术时间为120分钟（IQR 90 - 150），10例患者（5%）需要中转开腹手术。恶性肿瘤患者的中位淋巴结清扫数量为21个（IQR 15 - 30），未发现切缘阳性。有2例死亡，29例严重并发症（14.5%），7例患者因术后并发症需要再次手术。中位术后住院时间为4天（IQR 3 - 6），13例患者（6.5%）在出院后30天内再次入院。
对于大多数良性和恶性结直肠疾病，腹腔镜结直肠手术是可行的，中转率和并发症发生率低，住院时间短。
