Hsu Tzu-Chi
Division of Colon and Rectal Surgery, Department of Surgery, Taipei Mackay Memorial Hospital, Taiwan.
Am Surg. 2008 Sep;74(9):824-6; discussion 827-8.
Laparoscopic resection has become one of the choices for colectomy for various colon and rectal diseases in recent years. Despite some uncertainties of laparoscopic procedures, especially during cancer surgery, its popularity has forced surgeons to pursue the approach. One of the concerns is inadequate examination of the intra-abdominal organs with a laparoscope. This study is a retrospective analysis of a single surgeon's experience of the frequencies of unexpected findings during laparotomies. From July 1990 to November 2005, 2775 patients with various colorectal diseases receiving laparotomies by a single surgeon were analyzed. Among them, 2282 patients were operated for primary colorectal cancer. Excluded were patients who did not receive a formal laparotomy, who had a recent laparotomy, who had peritoneal and omental metastasis, and whose pathology did not attract attention for management. Exploration of the entire peritoneal cavity was performed for all cases in the series. There were 1423 males and 1352 females. Ages ranged from 12 to 94 years, averaging 62.6-years-old. Forty-six patients (1.7%) were found to have unexpected intra-abdominal lesions during laparotomies. Eleven patients were found to have synchronous colorectal cancers; five patients were found to have unexpected liver metastases; three patients each were found to have gastric cancers, stromal tumors of the small bowel, and ectopic pancreas; two patients each were found to have gastric leiomyosarcomas, pancreatic cancers, mucoceles of the appendix, ulcers of the small intestine, bleeding Meckel's diverticula, pancreatitis, and perforations of the ileum; one patient each was found to have gall bladder cancer, malignant carcinoid tumor, pheochromocytoma, diverticulitis of the jejunum, diverticulitis of the colon, duplication of the colon, and aortic aneurysm larger than 6 cm. Forty-one of the lesions were likely to be missed by laparoscope. This experience suggests that incomplete laparotomies might miss various pathologies. Laparoscopy is not a complete form of laparotomy because of loss of tactile sensation. Laparoscopy might result in an inadequate or inappropriate management due to misdiagnosis.
近年来，腹腔镜切除术已成为各种结肠和直肠疾病行结肠切除术的选择之一。尽管腹腔镜手术存在一些不确定性，尤其是在癌症手术中，但它的普及促使外科医生采用这种方法。其中一个担忧是使用腹腔镜对腹腔内器官的检查不充分。本研究是对一位外科医生剖腹手术期间意外发现频率的经验进行回顾性分析。1990年7月至2005年11月，对一位外科医生进行剖腹手术的2775例各种结直肠疾病患者进行了分析。其中，2282例患者因原发性结直肠癌接受手术。排除未接受正规剖腹手术、近期有剖腹手术史、有腹膜和网膜转移以及病理结果对治疗无影响的患者。该系列所有病例均对整个腹腔进行了探查。有男性1423例，女性1352例。年龄范围为12至94岁，平均62.6岁。46例患者（1.7%）在剖腹手术期间发现有意外的腹腔内病变。11例患者发现有同步性结直肠癌；5例患者发现有意外的肝转移；3例患者分别发现有胃癌、小肠间质瘤和异位胰腺；2例患者分别发现有胃平滑肌肉瘤、胰腺癌、阑尾黏液囊肿、小肠溃疡、梅克尔憩室出血、胰腺炎和回肠穿孔；1例患者分别发现有胆囊癌、恶性类癌肿瘤、嗜铬细胞瘤、空肠憩室炎、结肠憩室炎、结肠重复畸形和直径大于6cm的主动脉瘤。其中41处病变很可能会被腹腔镜漏诊。这一经验表明，不完全的剖腹手术可能会漏诊各种病变。由于失去触觉，腹腔镜检查并非完整的剖腹手术形式。腹腔镜检查可能因误诊导致治疗不足或不当。
