Department of Surgery, The Mount Sinai Medical Center, 1010 Fifth Avenue, New York, NY 10128, USA.
Surg Endosc. 2010 Jul;24(7):1616-20. doi: 10.1007/s00464-009-0819-2. Epub 2010 Mar 5.
To evaluate laparoscopic versus open subtotal colectomy (STC) in patients with ulcerative colitis (UC) requiring urgent or emergent operative intervention.
A retrospective review was performed of 90 patients with medically refractory UC who underwent STC with end ileostomy at The Mount Sinai Medical Center from 2002 to 2007. Patients with toxic megacolon were excluded. Univariate analysis was conducted by unpaired Student t-test and chi-square test. Results are presented as mean +/- 95% confidence interval.
Ninety patients underwent STC, 29 by laparoscopic and 61 by open approach. In patients undergoing laparoscopic versus open STC, intraoperative blood loss was decreased (130.4 +/- 38.4 vs. 201.4 +/- 43.2 ml, p < 0.05) and operative time prolonged (216.4 +/- 20.2 vs. 169.9 +/- 14.4 min, p < 0.01). In the absence of postoperative complication, hospital length of stay (4.5 +/- 0.7 vs. 6 +/- 1.3 days, p < 0.001) was shorter in laparoscopic versus open group. No mortalities occurred. Overall morbidity, 30-day readmission, and reoperation were equivalent regardless of operative approach. Wound complications were absent in the laparoscopic group compared with 21.4% in the open group (p < 0.01). Follow-up at a mean of 36 months demonstrated no difference in restoration of gastrointestinal continuity.
Laparoscopic STC confers the benefits of improved cosmesis, reduced intraoperative blood loss, negligible wound complications, and shorter hospital stay. Laparoscopy is a feasible and safe alternative to open STC in patients with UC refractory to medical therapy requiring urgent or emergent operation.
评估溃疡性结肠炎（UC）患者中腹腔镜与开腹次全结肠切除术（STC）的效果，这些患者需要紧急或急诊手术干预。
回顾性分析了 2002 年至 2007 年在西奈山医疗中心接受末端回肠造口术的 90 例药物难治性 UC 患者的 STC 病例。排除中毒性巨结肠患者。采用非配对 Student t 检验和卡方检验进行单因素分析。结果以平均值 +/- 95%置信区间表示。
90 例患者接受了 STC，其中 29 例采用腹腔镜，61 例采用开腹。与开腹 STC 相比，腹腔镜 STC 术中出血量减少（130.4 +/- 38.4 与 201.4 +/- 43.2 ml，p < 0.05），手术时间延长（216.4 +/- 20.2 与 169.9 +/- 14.4 min，p < 0.01）。在没有术后并发症的情况下，腹腔镜组的住院时间（4.5 +/- 0.7 与 6 +/- 1.3 天，p < 0.001）较短。无死亡病例。无论手术方式如何，总发病率、30 天再入院率和再次手术率均相当。腹腔镜组无伤口并发症，而开腹组为 21.4%（p < 0.01）。平均随访 36 个月后，两组在恢复胃肠道连续性方面无差异。
腹腔镜 STC 具有改善美容效果、减少术中出血量、几乎没有伤口并发症和缩短住院时间的优势。对于药物治疗无效、需要紧急或急诊手术的 UC 患者，腹腔镜 STC 是一种可行且安全的替代开腹手术的方法。
