Procacciante Fabio, Flati Donato, Diamantini Giulia, Angelakis Konstantinos, Cerioli Alessandra, Gaj Fabio, Picozzi Pietro, Trecca Antonello, di Seri Marisa
U.O.C. Chirurgia Generale ed Endocrina, Azienda Policlinico Umberto I, Università degli Studi La Sapienza di Roma.
Chir Ital. 2008 May-Jun;60(3):329-36.
In this preliminary retrospective study, severe postoperative complications following surgery for colorectal cancer were analysed, comparing the results obtained with open versus laparoscopic colectomy. Over the period 2005-2007, 50 patients (29 female, 21 male; age range: 32-85 years) underwent surgical treatment for colorectal-anal cancer. Twenty-nine (58%) were submitted to the traditional open technique and 21 (42%) to the laparoscopic technique. No mortality occurred with either technique. None of the cases submitted to laparoscopy presented anastomotic dehiscence or severe intraoperative bleeding. In the group submitted to open surgery, 3 cases of severe complications occurred (10.3%), consisting in acute faecal peritonitis due to immediate dehiscence of the colorectal anastomosis; angulation of the intestinal loop with microdehiscence of the ileo-colic anastomosis; and pulmonary embolism. In the group submitted to laparoscopic surgery, 2 cases of severe complications occurred (9.5%), consisting in enterorrhagia due to haemoperitoneum; and intrafascial haematoma due to haemorrhage of the epigastric artery. The overall complication rate was 10%, corresponding to the minimum values reported in the literature. No statistically significant difference was observed in the incidence of these complications with the two methods employed. A very low incidence of minor complications was observed, limited to repercussions on the postoperative course. Furthermore, the laparoscopic technique led to early canalisation, a reduction in hospital stay, less need of drugs (antibiotics and pain killers) and better aesthetic results. The advantages obtained with the laparoscopic technique, with no significant differences in severe complications, indicate that this approach is preferable to the traditional technique in colorectal surgery for cancer.
在这项初步回顾性研究中，对结直肠癌手术后的严重术后并发症进行了分析，比较了开腹与腹腔镜结肠切除术的结果。在2005年至2007年期间，50例患者（29例女性，21例男性；年龄范围：32至85岁）接受了结直肠癌手术治疗。29例（58%）采用传统开腹技术，21例（42%）采用腹腔镜技术。两种技术均未发生死亡。接受腹腔镜检查的病例均未出现吻合口裂开或严重术中出血。在接受开放手术的组中，发生了3例严重并发症（10.3%），包括结肠直肠吻合口立即裂开导致的急性粪性腹膜炎；肠袢成角伴回结肠吻合口微裂开；以及肺栓塞。在接受腹腔镜手术的组中，发生了2例严重并发症（9.5%），包括腹腔积血导致的肠出血；以及腹壁上动脉出血导致的筋膜内血肿。总体并发症发生率为10%，与文献报道的最小值相当。采用的两种方法在这些并发症的发生率上未观察到统计学显著差异。观察到轻微并发症的发生率非常低，仅限于对术后病程的影响。此外，腹腔镜技术导致早期肠道通畅、住院时间缩短、药物（抗生素和止痛药）需求减少以及美容效果更好。腹腔镜技术获得的优势，在严重并发症方面无显著差异，表明在结直肠癌手术中，这种方法比传统技术更可取。
