Tjandra Joe J, Chan Miranda K Y, Yeh Chung Hung
Department of Colorectal Surgery, Epworth Hospital, University of Melbourne, Melbourne, Australia.
Dis Colon Rectum. 2008 Jan;51(1):26-31. doi: 10.1007/s10350-007-9107-1. Epub 2007 Dec 18.
A standard laparoscopic-assisted operation can be conducted with colorectal anastomosis performed after extraction of specimen and insertion of a pursestring via a small left iliac fossa or suprapubic incision, or completed via hand-assisted laparoscopic technique with a 7-cm to 8-cm suprapubic incision. This study compares the short-term outcomes of either technique.
Sixty-three consecutive patients undergoing laparoscopic-assisted ultralow anterior resection or total mesorectal excision for rectal cancer were examined. The laparoscopic-assisted group (n = 31) had standard laparoscopic-assisted resection, whereas the hand-assisted laparoscopic group (n = 32) had a 7-cm to 8-cm suprapubic incision to allow an open colorectal anastomosis. In patients who were obese or have had multiple abdominal surgeries, the hand-assisted approach was generally favored. All patients had a diverting ileostomy.
There was no conversion in either group. Mean operating time was significantly longer in the laparoscopic-assisted group (188.2 vs. 169.8 minutes; P < 0.0001). Mean duration for narcotic analgesia (1.65 vs. 3.38 days, P < 0.0001), mean time to flatus (1.97 vs. 3.19 days, P < 0.0001), and mean duration of intravenous hydration (2.45 vs. 3.88 days, P < 0.0001) were longer in the hand-assisted laparoscopic group. However, the mean length of hospital stay (5.8 vs. 5.9 days, P = 0.379) was similar. There was no major surgical complication in either group; chest infection, wound infection, and thrombophlebitis were similar between the laparoscopic-assisted group and the hand-assisted laparoscopic group. Adequacy of specimen harvest (distal tumor margins, P = 0.995; circumferential resection margin, P = 0.946; number of lymph nodes, P = 0.845) was similar.
Although both laparoscopic-assisted and hand-assisted laparoscopic surgeries are safe and feasible for ultralow anterior resection, the hand-assisted technique significantly shortens operating time.
标准的腹腔镜辅助手术可在标本取出后经左下腹小切口或耻骨上切口插入荷包缝线进行结直肠吻合，或通过耻骨上7至8厘米切口的手辅助腹腔镜技术完成。本研究比较了这两种技术的短期疗效。
对63例连续接受腹腔镜辅助超低位前切除术或直肠癌全直肠系膜切除术的患者进行检查。腹腔镜辅助组（n = 31）采用标准腹腔镜辅助切除术，而手辅助腹腔镜组（n = 32）采用7至8厘米的耻骨上切口以进行开放结直肠吻合。对于肥胖或有多次腹部手术史的患者，一般倾向于采用手辅助方法。所有患者均行转流性回肠造口术。
两组均无中转开腹。腹腔镜辅助组的平均手术时间明显更长（188.2对169.8分钟；P < 0.0001）。手辅助腹腔镜组的平均麻醉镇痛时间（1.65对3.38天，P < 0.0001）、平均排气时间（1.97对3.19天，P < 0.0001）和平均静脉补液时间（2.45对3.88天，P < 0.0001）更长。然而，平均住院时间相似（5.8对5.9天，P = 0.379）。两组均无重大手术并发症；腹腔镜辅助组和手辅助腹腔镜组之间的肺部感染、伤口感染和血栓性静脉炎情况相似。标本切除的充分性（肿瘤远端切缘，P = 0.995；环周切缘，P = 0.946；淋巴结数量，P = 0.845）相似。
虽然腹腔镜辅助手术和手辅助腹腔镜手术对于超低位前切除术都是安全可行的，但手辅助技术显著缩短了手术时间。
