Polle S W Bas, van Koperen Paul J, van Berge Henegouwen Mark I, Slors J F M Frederik, Stokkers Pieter C F, Bemelman Willem A
Academisch Medisch Centrum/Universiteit van Amsterdam, Afd. Heelkunde, Amsterdam, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:B284.
To carry out a review of the literature for the short- and long-term effects of various laparoscopic operations in the inflammatory bowel diseases ulcerative colitis and Crohn's disease and to compare these operations with open surgical procedures.
Review of the literature.
PubMed (Medline), Embase and Cochrane databases were searched for randomised clinical trials and meta-analyses on this topic, published between January 1991 and August 2008. If no level A1, A2 or A2B studies were found, we searched for the best available evidence.
For Crohn's disease, there was level A2 evidence that, in comparison with open surgery, in experienced hands laparoscopic ileocaecal resection enhanced recovery and led to a shorter hospital stay and lower costs. Following laparoscopic surgery, subjective body image and cosmetic appearance scores were higher, when compared in the long term. In patients with ulcerative colitis, the expected benefits of laparoscopic proctocolectomy have not yet been demonstrated in a randomised study. Although there was a trend towards a reduced hospital stay (1.6 days) when laparoscopy proctocolectomy was performed, the operating time was 1.5 h longer than in conventional surgery. Body image and cosmetic appearance scores were also higher here when compared in the long term.
Laparoscopic ileocaecal resection is preferable in Crohn's disease, provided that it is performed in a centre with sufficient expertise in laparoscopic surgery. In patients with ulcerative colitis, laparoscopic proctocolectomy with construction of an ileoanal pouch is indicated in young active patients who are concerned for their appearance. Given its complexity, this operation should be performed only in specialist centres.
对各种腹腔镜手术治疗炎症性肠病（溃疡性结肠炎和克罗恩病）的短期和长期效果进行文献综述，并将这些手术与开放手术进行比较。
文献综述。
检索PubMed（Medline）、Embase和Cochrane数据库，查找1991年1月至2008年8月发表的关于该主题的随机临床试验和荟萃分析。如果未找到A1、A2或A2B级研究，我们则寻找现有最佳证据。
对于克罗恩病，有A2级证据表明，与开放手术相比，在经验丰富的医生手中，腹腔镜回盲部切除术能促进恢复，缩短住院时间并降低费用。从长期来看，腹腔镜手术后患者的主观身体形象和美观评分更高。对于溃疡性结肠炎患者，腹腔镜直肠结肠切除术的预期益处尚未在随机研究中得到证实。虽然进行腹腔镜直肠结肠切除术时住院时间有缩短趋势（1.6天），但其手术时间比传统手术长1.5小时。从长期来看，这里的身体形象和美观评分也更高。
对于克罗恩病，若在腹腔镜手术有足够专业知识的中心进行，腹腔镜回盲部切除术更为可取。对于溃疡性结肠炎患者，对于在意外观的年轻活跃患者，可考虑行腹腔镜直肠结肠切除术并构建回肠肛管储袋。鉴于其复杂性，该手术应仅在专科中心进行。
