手辅助腹腔镜与腹腔镜结直肠手术：一项多中心、前瞻性、随机试验

Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial.

作者信息

Marcello Peter W, Fleshman James W, Milsom Jeffrey W, Read Thomas E, Arnell Tracey D, Birnbaum Elisa H, Feingold Daniel L, Lee Sang W, Mutch Matthew G, Sonoda Toyooki, Yan Yan, Whelan Richard L

机构信息

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

出版信息

Dis Colon Rectum. 2008 Jun;51(6):818-26; discussion 826-8. doi: 10.1007/s10350-008-9269-5. Epub 2008 Apr 17.

DOI:10.1007/s10350-008-9269-5

PMID:18418653

Abstract

PURPOSE

This study was designed to compare short-term outcomes after hand-assisted laparoscopic vs. straight laparoscopic colorectal surgery.

METHODS

Eleven surgeons at five centers participated in a prospective, randomized trial of patients undergoing elective laparoscopic sigmoid/left colectomy and total colectomy. The study was powered to detect a 30-minute reduction in operative time between hand-assisted laparoscopic and straight laparoscopic groups.

RESULTS

There were 47 hand-assisted patients (33 sigmoid/left colectomy, 14 total colectomy) and 48 straight laparoscopic patients (33 sigmoid/left colectomy, 15 total colectomy). There were no differences in the patient age, sex, body mass index, previous surgery, diagnosis, and procedures performed between the hand-assisted and straight laparoscopic groups. Resident participation in the procedures was similar for all groups. The mean operative time (in minutes) was significantly less in the hand-assisted laparoscopic group for both the sigmoid colectomy (175 +/- 58 vs. 208 +/- 55; P = 0.021) and total colectomy groups (time to colectomy completion, 127 +/- 31 vs. 184 +/- 72; P = 0.015). There were no apparent differences in the time to return of bowel function, tolerance of diet, length of stay, postoperative pain scores, or narcotic usage between the hand-assisted laparoscopic and straight laparoscopic groups. There was one (2 percent) conversion in the hand-assisted laparoscopic group and six (12.5 percent) in the straight laparoscopic group (P = 0.11). Complications were similar in both groups (hand-assisted, 21 percent vs. straight laparoscopic, 19 percent; P = 0.68).

CONCLUSIONS

In this prospective, randomized study, hand-assisted laparoscopic colorectal surgery resulted in significantly shorter operative times while maintaining similar clinical outcomes as straight laparoscopic techniques for patients undergoing left-sided colectomy and total abdominal colectomy.

摘要

目的

本研究旨在比较手辅助腹腔镜与传统腹腔镜结直肠手术的短期疗效。

方法

五个中心的11名外科医生参与了一项针对择期腹腔镜乙状结肠/左半结肠切除术和全结肠切除术患者的前瞻性随机试验。该研究旨在检测手辅助腹腔镜组与传统腹腔镜组之间手术时间减少30分钟的差异。

结果

手辅助组有47例患者（33例行乙状结肠/左半结肠切除术，14例行全结肠切除术），传统腹腔镜组有48例患者（33例行乙状结肠/左半结肠切除术，15例行全结肠切除术）。手辅助组与传统腹腔镜组在患者年龄、性别、体重指数、既往手术史、诊断及手术方式方面无差异。所有组住院医师参与手术的情况相似。乙状结肠切除术手辅助腹腔镜组的平均手术时间（分钟）显著短于传统腹腔镜组（175±58对208±55；P = 0.021），全结肠切除术组也是如此（完成结肠切除的时间，127±31对184±72；P = 0.015）。手辅助腹腔镜组与传统腹腔镜组在肠功能恢复时间、饮食耐受性、住院时间、术后疼痛评分或麻醉药物使用方面无明显差异。手辅助腹腔镜组有1例（2%）中转开腹，传统腹腔镜组有6例（12.5%）中转开腹（P = 0.11）。两组并发症发生率相似（手辅助组21%对传统腹腔镜组19%；P = 0.68）。