Department of Surgery, Division of Laparoscopic Surgery, Mount Sinai Medical Center, 5 East 98th Street, Box 1259, New York, NY, USA.
Surg Endosc. 2009 Oct;23(10):2380-4. doi: 10.1007/s00464-009-0362-1. Epub 2009 Mar 5.
Laparoscopic resection for Crohn's disease has had a slow adoption rate in gastrointestinal surgery. This is not unexpected considering the inflammatory nature of the disease, the need for reoperative surgery, and the presence of fistulas. The authors review their experience with 335 laparoscopic resections for Crohn's disease over the past 15 years.
This study is a retrospective analysis of a prospective database from one surgeon at the Mount Sinai Hospital, New York, NY.
Since 1993, 335 patients with Crohn's disease in the current series have undergone laparoscopic resection. The mean age of the patients was 39 years, and 54% of the patients were women. In most cases, the indication for surgery was intestinal obstruction (73%) or abdominal pain (16%). The most common operation was primary ileocolic resection, performed for 178 cases (49%). Secondary ileocolic resections were performed for 20% and small bowel resections for 11% of the cases. Of the 117 patients with enteric fistulas, 45% had multiple fistulas. There were 80 enteroenteric, 51 ileosigmoid, 33 enteroabdominal wall, and 22 ileovesical fistulas. Multiple resections were performed for 33 patients (9%). Eight conversions occurred (2%), primarily because of large inflammatory masses involving the intestinal mesentery. The mean length of hospital stay was 5 days, and the mean operative time was 177 min (range, 62-400 min). There were no mortalities. The complications were primarily bowel obstruction, anastamotic leak, and postoperative bleeding, resulting in a postoperative complication rate of 13%.
This review summarizes the largest series of laparoscopic resection for Crohn's disease to date. The most common operation performed was ileocolic resection. Fistulous disease is common, but it is not a contraindication to laparoscopic resection. These cases can be managed safely and with acceptable morbidity in experienced hands.
腹腔镜下克罗恩病切除术在胃肠外科中的应用率一直较低。考虑到疾病的炎症性质、需要再次手术以及瘘管的存在，这种情况并不出人意料。作者回顾了过去 15 年来他们在 335 例克罗恩病腹腔镜切除术中的经验。
这是一项来自纽约西奈山医院的一位外科医生的前瞻性数据库的回顾性分析。
自 1993 年以来，当前系列中的 335 例克罗恩病患者接受了腹腔镜切除术。患者的平均年龄为 39 岁，54%为女性。大多数患者的手术指征是肠梗阻（73%）或腹痛（16%）。最常见的手术是原发性回结肠切除术，共进行了 178 例（49%）。其次是二次回结肠切除术（20%）和小肠切除术（11%）。在 117 例肠瘘患者中，45%有多个瘘管。其中 80 例为肠肠瘘，51 例为回结肠瘘，33 例为肠腹壁瘘，22 例为回肠膀胱瘘。33 例患者（9%）进行了多次切除术。8 例转为开腹手术（2%），主要原因是肠系膜涉及大量炎症性肿块。平均住院时间为 5 天，平均手术时间为 177 分钟（范围 62-400 分钟）。无死亡病例。并发症主要为肠梗阻、吻合口漏和术后出血，术后并发症发生率为 13%。
本综述总结了迄今为止最大的一组腹腔镜下克罗恩病切除术。最常见的手术是回结肠切除术。瘘管病很常见，但它不是腹腔镜切除的禁忌症。在有经验的医生手中，这些病例可以安全地进行，并且发病率可以接受。
