Vrzgula A, Bober J, Lukácová Z, Tóth E
I. chirurgická klinika LF UPJS a FNLP Kosice, Slovenská republika.
Rozhl Chir. 2008 Aug;87(8):432-7.
Proctocolectomy with ileal pouch-anal anastomosis (restorative proctocolectomy) became a method of choice in surgical treatment of familial adenomatous polyposis (FAP) and ulcerative colitis (UC) during last years. The improvement of laparoscopic technique in colorectal surgery permit to perform this operation by miniinvasive approach.
Authors present the informations about two patients (one with FAP and one with UC) in whom they perform the laparoscopic proctocolectomy with ileal pouch-anal anastomosis and protective loop ileostomy.
Although authors present their first experiences with corresponding operating time (390 and 360 minutes), they noticed hopeful postoperative period with quickly return of bowel movement, early return of oral intake and rapid reconvalescence. They observed one postoperative complication--wound infection. The longer postoperative hospital stay (17 and 19 days) may be related to the consistent management of protective ileostomy and precise postoperative follow-up.
Restorative proctocolectomy is possible to perform by miniinvasive approach having the adequate experiences with laparoscopic colorectal operations and open procedures for inflammatory bowel diseases. The more procedures experiences allow to consider the benefit of laparoscopic approach for patients.
在过去几年中，回肠储袋肛管吻合术的直肠结肠切除术（恢复性直肠结肠切除术）已成为家族性腺瘤性息肉病（FAP）和溃疡性结肠炎（UC）外科治疗的首选方法。结直肠手术中腹腔镜技术的改进使得可以通过微创方法进行该手术。
作者介绍了两名患者（一名患有FAP，一名患有UC）的信息，他们对这两名患者进行了腹腔镜直肠结肠切除术并进行回肠储袋肛管吻合术及保护性回肠造口术。
尽管作者介绍了他们在相应手术时间（390分钟和360分钟）方面的首次经验，但他们注意到术后恢复情况良好，肠道蠕动迅速恢复，早期恢复经口进食且康复迅速。他们观察到一例术后并发症——伤口感染。术后住院时间较长（17天和19天）可能与保护性回肠造口的持续管理及精确的术后随访有关。
对于有足够腹腔镜结直肠手术和炎性肠病开放手术经验的医生来说，通过微创方法进行恢复性直肠结肠切除术是可行的。更多的手术经验使我们能够考虑腹腔镜手术对患者的益处。
