Tan P Y, Stephens J H, Rieger N A, Hewett P J
Colorectal Unit, Division of Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, 5011, Australia.
Surg Endosc. 2008 Jul;22(7):1708-14. doi: 10.1007/s00464-007-9702-1. Epub 2007 Dec 11.
Conversion to an open procedure during laparoscopically assisted colorectal resection may be necessary because of technical, patient, or pathologic factors. Recent literature has indicated that converted patients may have poorer outcomes than those undergoing open or completed laparoscopically assisted procedure. This study aimed to audit the authors' experience with laparoscopically assisted colectomy and to assess the clinical outcomes of patients undergoing conversion.
All laparoscopic right hemicolectomies or anterior resections performed at seven South Australian hospitals from 1997 to 2006 were reviewed. Data pertaining to patient sex, age, American Society of Anesthesiology (ASA) score, pathology, operative outcomes including operating time, conversion, reason for conversion, length of hospital stay, and intra- and postoperative complications were analyzed.
Laparoscopic anterior resection had a higher rate of open conversion than laparoscopic right hemicolectomy (18.7% vs 10.4%; p = 0.028). In the right hemicolectomy group, none of the investigated risk factors for conversion were statistically significant, and the morbidity rates for the two groups were similar. The median hospital stay was significantly longer in the anterior resection group (p < 0.001), and the wound morbidity rate was higher in the converted group (12.8% vs 3.0%; p = 0.022). Age older than 75 years and a high ASA status were independent risk factors for conversion in anterior resection.
Conversion of laparoscopic anterior resection to open procedure is associated with higher wound morbidity and a longer hospital stay. The authors recommend that surgeons carefully consider the selection of patients 75 years of age or older and high ASA status for laparoscopic anterior resection.
在腹腔镜辅助结直肠切除术中，由于技术、患者或病理因素，可能需要转为开放手术。最近的文献表明，转为开放手术的患者可能比接受开放手术或完成腹腔镜辅助手术的患者预后更差。本研究旨在审查作者在腹腔镜辅助结肠切除术方面的经验，并评估转为开放手术患者的临床结局。
回顾了1997年至2006年在南澳大利亚七家医院进行的所有腹腔镜右半结肠切除术或前切除术。分析了与患者性别、年龄、美国麻醉医师协会（ASA）评分、病理、手术结局（包括手术时间、转为开放手术、转为开放手术的原因、住院时间以及术中和术后并发症）相关的数据。
腹腔镜前切除术的开放手术转换率高于腹腔镜右半结肠切除术（18.7%对10.4%；p = 0.028）。在右半结肠切除术组中，所调查的转为开放手术的危险因素均无统计学意义，两组的发病率相似。前切除术组的中位住院时间明显更长（p < 0.001），转为开放手术组的伤口发病率更高（12.8%对3.0%；p = 0.022）。年龄大于75岁和ASA状态高是前切除术转为开放手术的独立危险因素。
腹腔镜前切除术转为开放手术与更高的伤口发病率和更长的住院时间相关。作者建议外科医生在选择75岁及以上和ASA状态高的患者进行腹腔镜前切除术时应谨慎考虑。
