Braga Marco, Frasson Matteo, Vignali Andrea, Zuliani Walter, Di Carlo Valerio
Department of Surgery, San Raffaele University, Milan, Italy.
Ann Surg. 2007 Dec;246(6):1010-4; discussion 1014-5. doi: 10.1097/SLA.0b013e31815c4065.
The primary goal of this study was to clarify whether a laparoscopic (LPS) approach could be considered the dominant strategy in patients undergoing right colectomy.
Because few nonrandomized or small sized studies have been carried out so far, definitive conclusions about the role of LPS right colectomy cannot be drawn.
Two hundred twenty-six patients, candidates for right colectomy, were randomly assigned to LPS (n = 113) or open (n = 113) resection. The postoperative care protocol was the same for both groups. Trained members of the surgical staff who were not involved in the study registered postoperative morbidity. Follow-up was carried out for 30 days after hospital discharge. The following costs were calculated: surgical instruments, operative room occupation, routine care, postoperative morbidity, and hospitalization.
Conversion rate in the LPS group was 2.6% (3 of 113). Operative time (in minutes) was longer in the LPS group (131 vs. 112, P = 0.01). Postoperative morbidity rate was 18.6% in the open group and 13.3% in the LPS group (P = 0.31). Postoperative stay was one day longer in the open group (P = 0.002). No difference was found in postoperative quality of life. The additional operative charge in the LPS group was euro980 per patient randomized (euro821 for surgical instruments and euro159 for longer operative time). The savings in the LPS group was euro390 per patient randomized (euro144 for shorter length of hospital stay and euro246 for the lower cost of postoperative morbidity). The net balance resulted in a euro590 extra charge per patient randomly allocated to the LPS group.
LPS slightly improved postoperative recovery. This translated into a savings that covered only 40% of the extra operative charge. Therefore, open right colectomy could be still considered an effective procedure.
本研究的主要目标是阐明腹腔镜手术（LPS）方法是否可被视为右半结肠切除术患者的主要策略。
由于目前进行的非随机或小规模研究较少，因此无法就LPS右半结肠切除术的作用得出明确结论。
226例适合右半结肠切除术的患者被随机分配接受LPS手术（n = 113）或开放手术（n = 113）切除。两组的术后护理方案相同。未参与研究的经过培训的手术人员记录术后发病率。出院后进行30天的随访。计算了以下费用：手术器械、手术室占用、常规护理、术后发病率和住院费用。
LPS组的中转率为2.6%（113例中的3例）。LPS组的手术时间（分钟）更长（131对112，P = 0.01）。开放组的术后发病率为18.6%，LPS组为13.3%（P = 0.31）。开放组的术后住院时间长一天（P = 0.002）。术后生活质量未发现差异。LPS组每位随机分组患者的额外手术费用为980欧元（手术器械821欧元，手术时间延长159欧元）。LPS组每位随机分组患者节省390欧元（住院时间缩短节省144欧元，术后发病率成本降低节省246欧元）。净余额为随机分配到LPS组的每位患者额外收取590欧元费用。
LPS略微改善了术后恢复。这转化为节省的费用仅覆盖额外手术费用的40%。因此，开放右半结肠切除术仍可被视为一种有效的手术方法。
