腹腔镜与开腹结直肠手术后粘连形成减少。

Reduced adhesion formation following laparoscopic versus open colorectal surgery.

作者信息

Dowson H M, Bong J J, Lovell D P, Worthington T R, Karanjia N D, Rockall T A

机构信息

Minimal Access Therapy Training Unit, University of Surrey, Guildford, UK.

出版信息

Br J Surg. 2008 Jul;95(7):909-14. doi: 10.1002/bjs.6211.

DOI:10.1002/bjs.6211

PMID:18509861

Abstract

BACKGROUND

Adhesion formation is common after abdominal surgery. This study aimed to compare the extent of adhesion formation following laparoscopic and open colorectal surgery.

METHODS

An observational study was undertaken to identify adhesions in patients undergoing laparoscopy after previous laparoscopic or open colectomy. Adhesions were scored according to a system validated for interobserver (median kappa = 0.80) and intraobserver (kappa = 0.82) agreement. The primary endpoint was the overall adhesion score (0-10); a secondary endpoint was the adhesion score at the main incision site (0-6).

RESULTS

Forty-six patients were recruited (13 laparoscopic and 33 open colectomy). In most patients (n = 29), laparoscopy was performed for tumour staging before liver resection. The median (interquartile range) overall adhesion score was 7 (5-8) in the open group and 0 (0-3) in the laparoscopic group (P < 0.001). A similar difference was found for the main incision score: 6 (4-6) versus 0 (0-0) (P < 0.001).

CONCLUSION

There may be a reduction in adhesion formation following laparoscopic compared with open colectomy, although the small sample size limits this conclusion.

摘要

背景

腹部手术后粘连形成很常见。本研究旨在比较腹腔镜结直肠手术和开放结直肠手术后粘连形成的程度。

方法

进行一项观察性研究，以确定先前接受过腹腔镜或开放结肠切除术的患者在接受腹腔镜检查时的粘连情况。粘连根据一种经观察者间（中位数kappa = 0.80）和观察者内（kappa = 0.82）一致性验证的系统进行评分。主要终点是总体粘连评分（0 - 10）；次要终点是主切口部位的粘连评分（0 - 6）。

结果

招募了46例患者（13例行腹腔镜结肠切除术，33例行开放结肠切除术）。在大多数患者（n = 29）中，在肝切除术前进行腹腔镜检查以进行肿瘤分期。开放组的中位数（四分位间距）总体粘连评分为7（5 - 8），腹腔镜组为0（0 - 3）（P < 0.001）。主切口评分也有类似差异：6（4 - 6）对0（0 - 0）（P < 0.001）。