Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Int J Colorectal Dis. 2010 Aug;25(8):949-57. doi: 10.1007/s00384-010-0898-5. Epub 2010 Feb 17.
Crohn's disease is established in laparoscopic surgery due to partial bowel dissection and low postoperative complication rate. However, laparoscopic surgery for ulcerative colitis remains further discussed even if the trend of minimally invasive technique exists. This study is to figure out how laparoscopic surgery works for ulcerative colitis.
Sixteen controlled trials were identified through the search strategy mentioned below. There was only one prospective randomized study among the studies selected. A meta-analysis pooled the outcome effects of laparoscopic surgery and open surgery was performed. Fixed effect model or random effect model was respectively used depending on the heterogeneity test of trials.
Postoperative fasting time and postoperative hospital stay were shorter in laparoscopic surgery for ulcerative colitis (-1.37 [-2.15, -0.58], -3.22 [-4.20, -2.24], respectively, P < 0.05). Overall complication rate was higher in open surgery, compared with laparoscopic surgery (54.8% versus 39.3%, P = 0.004). However, duration of laparoscopic surgery for ulcerative colitis was extended compared with open surgery (weighted mean difference 69.29 min, P = 0.04). As to recovery of bowel function, peritoneal abscess, anastomotic leakage, postoperative bowel obstruction, wound infection, blood loss, and mortality, laparoscopic surgery did not show any superiority over open surgery. Re-operation rate was almost even (5.2% versus 7.3%). The whole conversion to open surgery was 4.2%.
Laparoscopic surgery for ulcerative colitis was at least as safe as open surgery, even better in postoperative fasting time, postoperative hospital stay, and overall complication rate. However, clinical value of laparoscopic surgery for ulcerative colitis needed further evaluation with more well-designed and long-term follow-up studies.
由于腹腔镜手术中部分肠管的解剖和较低的术后并发症发生率，克罗恩病已在腹腔镜手术中确立。然而，即使微创技术的趋势存在，溃疡性结肠炎的腹腔镜手术仍在进一步讨论中。本研究旨在探讨腹腔镜手术在溃疡性结肠炎中的作用。
通过以下搜索策略确定了 16 项对照试验。在所选择的研究中，只有一项前瞻性随机研究。对腹腔镜手术和开放手术的结果效果进行了荟萃分析。根据试验的异质性检验，分别使用固定效应模型或随机效应模型。
腹腔镜手术治疗溃疡性结肠炎的术后禁食时间和术后住院时间更短（分别为-1.37 [-2.15，-0.58]，-3.22 [-4.20，-2.24]，P < 0.05）。与腹腔镜手术相比，开放手术的总并发症发生率更高（54.8%对 39.3%，P = 0.004）。然而，溃疡性结肠炎腹腔镜手术的手术时间比开放手术延长（加权均数差 69.29 分钟，P = 0.04）。至于肠道功能恢复、腹腔脓肿、吻合口漏、术后肠梗阻、伤口感染、失血和死亡率，腹腔镜手术并不优于开放手术。再次手术率几乎相同（5.2%对 7.3%）。整个中转开腹率为 4.2%。
腹腔镜手术治疗溃疡性结肠炎至少与开放手术一样安全，在术后禁食时间、术后住院时间和总并发症发生率方面更好。然而，腹腔镜手术治疗溃疡性结肠炎的临床价值需要进一步评估，需要更多设计良好、长期随访的研究。
