Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Colorectal Dis. 2010 May;12(5):480-4. doi: 10.1111/j.1463-1318.2009.01843.x. Epub 2009 Mar 26.
There are a limited number of studies describing the role of minimally invasive colectomy for urgent or emergent conditions of the large bowel. We hypothesize that laparoscopic colectomy in urgent and emergent setting can be performed safely in select settings.
A cohort of patients treated at a single institution from 2001 to 2006 was identified from a prospective database. Patients who underwent open or minimally invasive surgery (MIS), including laparoscopic (LAP) or hand-assisted laparoscopic surgery (HALS) colectomy for urgent and emergent conditions were included.
A total of 68 [open 32, MIS 36 [HALS 22, LAP 14)] patients underwent urgent or emergent colectomy on our colorectal service during the 5-year time period. Patients with toxic colitis were more often selected for MIS. Patients with colon perforation or large bowel obstruction were more often selected for open surgery. The MIS group had a lower body mass index (BMI), lower American Society of Anesthesiologists fitness grade and was more likely to have been immunosuppressed. There was no difference in patient morbidity between the open and MIS groups. The MIS group had a longer median operative time and fewer cases of prolonged hospitalization.
We conclude that minimally invasive colectomy by experienced surgeons appears to be safe and effective for appropriately selected patients with emergent and urgent conditions of the large bowel.
目前仅有少数研究描述了微创结肠切除术在大肠急症或紧急情况下的作用。我们假设在特定情况下，腹腔镜结肠切除术在紧急情况下是安全的。
从一个前瞻性数据库中确定了 2001 年至 2006 年在一家医疗机构接受治疗的患者队列。纳入接受开腹或微创手术（MIS）治疗的患者，包括腹腔镜（LAP）或手助腹腔镜手术（HALS）结肠切除术，用于紧急和紧急情况。
在 5 年的时间内，我们的结直肠外科团队共有 68 例[开腹 32 例，MIS 36 例[HALS 22 例，LAP 14 例]）接受了紧急或紧急结肠切除术。中毒性结肠炎患者更常选择 MIS。结肠穿孔或大肠梗阻患者更常选择开腹手术。MIS 组的体重指数（BMI）较低，美国麻醉医师协会（ASA）功能分级较低，且更可能存在免疫抑制。开腹组和 MIS 组患者的发病率无差异。MIS 组的中位手术时间较长，住院时间延长的病例较少。
我们得出结论，经验丰富的外科医生进行的微创结肠切除术似乎对大肠急症和紧急情况下的适当选择患者是安全有效的。
