Hauenschild Lena, Bader Franz Georg, Laubert Tilman, Czymek Ralf, Hildebrand Philipp, Roblick Uwe Johannes, Bruch Hans-Peter, Mirow Lutz
Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
Int J Colorectal Dis. 2009 Jul;24(7):755-9. doi: 10.1007/s00384-009-0688-0. Epub 2009 Mar 13.
Endoscopic polypectomy still remains the cornerstone of therapy for colorectal polyps and adenomas. However, if colorectal polyps are too large or not accessible for endoscopic ablation or cannot be removed without an increased risk for perforation, operative procedures are required. In such circumstances, laparoscopic resection represents a minimally invasive alternative.
Between January 1993 and December 2004, more than 2,500 endoscopic polypectomies were performed at the Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany. In patients which could not be treated by endoscopic polypectomy due to size, location, and/or risk of complications, a laparoscopic colorectal resection was performed. All data were prospectively assessed in our "colorectal resection" database.
The database analysis revealed 58 patients with endoscopically not resectable colorectal polyps who underwent a laparoscopic colorectal resection (intend to treat). In 54 patients, the operative procedure could be finished by the laparoscopic approach (study population). The conversion rate was 6.9% (four of 58). An ileocolic resection was performed in 20 patients (37.0%), and 14 patients (25.9%) underwent an anterior rectal resection. A right colectomy was necessary in 12 patients (22.2%), and six patients (11.1%) underwent a sigmoid resection. In the remaining two patients, a left colectomy and a resection of the transverse colon were performed. Intra- and postoperative complications occurred in five patients (9.3%). Perioperative mortality was not registered. The histopathological work-up revealed benign disease in all cases.
Laparoscopic resection of colorectal polyps is a safe and minimally invasive technique for the management of benign colorectal tumors. Thus, the laparoscopic approach to endoscopically not resectable polyps enriches the therapeutic spectrum.
内镜下息肉切除术仍然是结直肠息肉和腺瘤治疗的基石。然而，如果结直肠息肉太大或无法通过内镜切除，或者在不增加穿孔风险的情况下无法切除，则需要进行手术。在这种情况下，腹腔镜切除术是一种微创替代方法。
1993年1月至2004年12月期间，德国石勒苏益格-荷尔斯泰因大学吕贝克校区外科进行了2500多例内镜下息肉切除术。对于因大小、位置和/或并发症风险而无法通过内镜息肉切除术治疗的患者，进行了腹腔镜结直肠切除术。所有数据均在我们的“结直肠切除术”数据库中进行前瞻性评估。
数据库分析显示，58例内镜下不可切除的结直肠息肉患者接受了腹腔镜结直肠切除术（意向性治疗）。54例患者的手术可通过腹腔镜方法完成（研究人群）。转换率为6.9%（58例中的4例）。20例患者（37.0%）进行了回结肠切除术，14例患者（25.9%）接受了直肠前切除术。12例患者（22.2%）需要进行右半结肠切除术，6例患者（11.1%）接受了乙状结肠切除术。其余2例患者进行了左半结肠切除术和横结肠切除术。5例患者（9.3%）发生了术中及术后并发症。未记录围手术期死亡率。组织病理学检查显示所有病例均为良性疾病。
腹腔镜切除结直肠息肉是治疗良性结直肠肿瘤的一种安全且微创的技术。因此，腹腔镜治疗内镜下不可切除息肉丰富了治疗手段。
