Bergamaschi Roberto, Haughn Christopher, Reed James F, Arnaud Jean-Pierre
Division of Colon & Rectal Surgery, State University of New York, Stony Brook, New York 11794-8191, USA.
Dis Colon Rectum. 2009 Apr;52(4):651-6. doi: 10.1007/DCR.0b013e31819ed620.
The aim of this study was to assess the impact of laparoscopic ileocolic resection with intracorporeal vascular division and anastomosis on the outcome of patients with terminal ileal Crohn's disease.
Prospective data on patients undergoing laparoscopic ileocolic resection for Crohn's disease confined to terminal ileum and cecum with or without fistulas were reviewed. Exclusion criteria were frozen abdomen, recurrent Crohn's disease following resection, and perforated Crohn's disease. Laparoscopic ileocolic resection involved a lateral-to-medial approach encompassing ten sequential steps. Values were medians (range).
From January 1992 to June 2006, 80 laparoscopic ileocolic resections were attempted with a 1.2 percent conversion rate. Sixty-two women and 18 men, age 40 (19-55) years, had a body mass index of 26 (18-37) and an American Society of Anesthesiologists' score of 1 (1-3), and 23.7 percent had previously undergone abdominal surgery. Operating time was 155 (130-210) minutes. Estimated blood loss was 250 (50-600) ml. Length of the skin incision at the specimen extraction site was 35 (30-44) mm. The complication/reoperation rate was 7.5 percent. The readmission rate was 3.7 percent. Except for smoking (P < 0.005), there were no significant differences between patients with and those without complications. The recurrence rate was 30 percent (24 of 80). The median time to recurrence was 64 months.
Laparoscopic ileocolic resection with intracorporeal vascular division and anastomosis resulted in a favorable outcome in selected patients with refractory terminal ileal Crohn's disease.
本研究旨在评估腹腔镜下经体内血管离断和吻合的回结肠切除术对末端回肠克罗恩病患者治疗效果的影响。
回顾性分析因局限于末端回肠和盲肠的克罗恩病（伴或不伴有瘘管）而接受腹腔镜回结肠切除术患者的前瞻性数据。排除标准为冰冻骨盆、切除术后复发性克罗恩病以及克罗恩病穿孔。腹腔镜回结肠切除术采用从外侧到内侧的入路，包括连续十个步骤。数据以中位数（范围）表示。
1992年1月至2006年6月，共尝试进行80例腹腔镜回结肠切除术，中转开腹率为1.2%。62例女性和18例男性，年龄40岁（19 - 55岁），体重指数为26（18 - 37），美国麻醉医师协会评分1分（1 - 3分），23.7%的患者既往接受过腹部手术。手术时间为155分钟（130 - 210分钟）。估计失血量为250毫升（50 - 600毫升）。标本取出部位皮肤切口长度为35毫米（30 - 44毫米）。并发症/再次手术率为7.5%。再次入院率为3.7%。除吸烟外（P < 0.005），有并发症和无并发症患者之间无显著差异。复发率为30%（80例中有24例）。复发的中位时间为64个月。
对于部分难治性末端回肠克罗恩病患者，腹腔镜下经体内血管离断和吻合的回结肠切除术可带来良好的治疗效果。
