腹腔镜治疗复发性克罗恩病：其疗效与原发性克罗恩病相比如何？

Laparoscopy for recurrent Crohn's disease: how do the results compare with the results for primary Crohn's disease?

机构信息

Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.

出版信息

Colorectal Dis. 2011 Mar;13(3):302-7. doi: 10.1111/j.1463-1318.2009.02133.x.

DOI:10.1111/j.1463-1318.2009.02133.x

PMID:19912288

Abstract

AIM

To assess the feasibility and outcomes of reoperative laparoscopic-assisted surgery for recurrent Crohn's disease compared with index laparoscopic resections.

METHOD

A retrospective analysis of a prospectively maintained database was performed from 2001 to 2008 on patients who had primary laparoscopy (group I) or reoperative laparoscopy for Crohn's disease (group II). Data collection included demographic and surgical data, and postoperative outcomes.

RESULTS

One hundred and thirty patients were included in this study, distributed as follows: group I, 80 patients with a mean age of 35 years; and group II, 50 patients with a mean age of 42 years. Preoperative American Society of Anesthesiologists score and body mass index were similar in both groups. Patients in group II had a longer period of disease (15.5 vs 8.9 years in groups I and II, respectively; P = 0.0002). Immunosuppressive therapy had been utilized in 66 (82.5%) and in 42 (84%) patients in groups I and II, respectively. Ileocolic resection was the most commonly performed procedure in both groups (82%), followed by subtotal colectomy. Conversion rates were 18.7 and 32% in groups I and II, respectively (P = 0.09). The mean operative time (182 vs 201 min) and mean blood loss (161 vs 202 ml) were not significantly different (P > 0.05); however, the overall incisional length was significantly longer in group II (6.7 vs 11.4 cm, P = 0.045). A stoma was created in 17 and 16% of patients in groups I and II, respectively. Overall, early postoperative complications were not statistically significantly different between the two groups (P > 0.05); anastomotic leak occurred in four (5%) and one (2%) patients (P = 0.65), and abdominal abscess in three (3.75%) and four (8%) patients (P = 0.56), in groups I and II, respectively. Reoperative rates were 10 and 6% (P = 0.53), and mean hospital stay was similar in groups I and II respectively (6.7 vs 7.5 days, respectively; P = 0.3266). There was no mortality.

CONCLUSION

The results of laparoscopic-assisted resection for recurrent Crohn's disease are similar to those for primary resection.

摘要

目的

评估与初次腹腔镜切除术相比，对复发性克罗恩病进行再次腹腔镜辅助手术的可行性和结果。

方法

对 2001 年至 2008 年期间行初次腹腔镜（I 组）或复发性腹腔镜（II 组）治疗的克罗恩病患者的前瞻性数据库进行回顾性分析。数据收集包括人口统计学和手术数据以及术后结果。

结果

本研究共纳入 130 例患者，分布如下：I 组 80 例，平均年龄 35 岁；II 组 50 例，平均年龄 42 岁。两组患者的术前美国麻醉医师协会评分和体重指数相似。II 组患者的疾病病程较长（I 组和 II 组分别为 15.5 年和 8.9 年；P = 0.0002）。66 例（82.5%）和 42 例（84%）I 组和 II 组患者分别接受了免疫抑制治疗。两组最常见的手术方式均为回肠结肠切除术（82%），其次是次全结肠切除术。I 组和 II 组的转化率分别为 18.7%和 32%（P = 0.09）。手术时间（182 分钟比 201 分钟）和术中出血量（161 毫升比 202 毫升）无显著差异（P > 0.05）；但 II 组的总切口长度明显更长（6.7 厘米比 11.4 厘米，P = 0.045）。I 组和 II 组分别有 17%和 16%的患者造口。总体而言，两组患者的早期术后并发症无统计学差异（P > 0.05）；吻合口漏分别发生在 4 例（5%）和 1 例（2%）患者（P = 0.65），腹部脓肿分别发生在 3 例（3.75%）和 4 例（8%）患者（P = 0.56），I 组和 II 组。再次手术率分别为 10%和 6%（P = 0.53），I 组和 II 组的平均住院时间分别为 6.7 天和 7.5 天（P = 0.3266）。无死亡病例。