Flores P, Bailez M M, Cuenca E, Fraire C
J.P.Garrahan Children's Hospital, Buenos Aires, Argentina.
Pediatr Surg Int. 2010 Sep;26(9):907-11. doi: 10.1007/s00383-010-2669-3. Epub 2010 Jul 15.
The aim of this study is to compare laparoscopic with open approach in the surgical treatment of ulcerative colitis (UC) MATERIAL AND METHODS: Between July 1991 and August 2009, 32 consecutive unselective patients with UC received surgical treatment. The population analyzed was divided into three groups: subtotal colectomy + ileocolostomy (Group 1), proctectomy + ileoanal pouch (Group 2), one-step proctocolectomy + ileoanal pouch (Group 3). We analyzed the mean operating time, postoperative oral intake, use of opiates, the length of hospital stay and postoperative morbidity in each group. Open and laparoscopic approaches were compared in each group retrospectively.
In Group 1 the mean operating time was longer for the laparoscopic group (301 vs. 197 min; p < 0.01). The length of postoperative stay was longer for the open group (8 vs. 19 days; p < 0.05) and the oral intake started earlier in the laparoscopic group (3, 5 vs. 6, 2 days; p = 0.05). No significant difference was found in the use of opiates (p = ns). A total of four major complications occurred in the laparoscopic group and another four in the open approach. In Group 2, there was no significant difference in operating time between laparoscopic and open approach. The laparoscopic group started earlier to tolerate (p < 0.05) and there were significantly differences in the use of narcotics and hospital stay (p < 0.05). General complications were related to the pouch. In Group 3 the mean operating time was longer for the laparoscopic group (470 vs. 330 min p < 0.05). Patients with a laparoscopic approach had a shorter hospital stay (5, 6 vs. 10 days; p < 0.05) and postoperative narcotic use and they started earlier to tolerate (p < 0.05). One major complication was presented in the laparoscopic procedure and two in the open approach.
Of the 165 patients with UC in our hospital, 32 underwent surgery. The laparoscopic approach seems feasible and safe. A single staged approach (Group 1 + Group 2) remains the most reasonable choice for most patients. One-step approach was done only in selected cases (Group 3). The advantages of laparoscopy, such as improved cosmetic aspects, shorter postoperative ileus and hospital stay, were observed in the laparoscopic colectomy, proctectomy and ileoanal pouch in our study.
本研究旨在比较腹腔镜手术与开放手术治疗溃疡性结肠炎（UC）的效果。
1991年7月至2009年8月，32例未经选择的UC患者接受了手术治疗。分析的人群分为三组：次全结肠切除术+回肠结肠造口术（第1组）、直肠切除术+回肠肛管贮袋术（第2组）、一期直肠结肠切除术+回肠肛管贮袋术（第3组）。我们分析了每组的平均手术时间、术后经口摄入量、阿片类药物的使用、住院时间和术后发病率。对每组的开放手术和腹腔镜手术方法进行回顾性比较。
在第1组中，腹腔镜组的平均手术时间较长（301对197分钟；p<0.01）。开放组的术后住院时间较长（8对19天；p<0.05），腹腔镜组经口摄入量开始时间较早（3.5对6.2天；p = 0.05）。阿片类药物的使用无显著差异（p =无统计学意义）。腹腔镜组共发生4例严重并发症，开放手术组发生4例。在第2组中，腹腔镜手术与开放手术的手术时间无显著差异。腹腔镜组开始耐受的时间较早（p<0.05），麻醉药物使用和住院时间有显著差异（p<0.05）。一般并发症与贮袋有关。在第3组中，腹腔镜组的平均手术时间较长（470对330分钟，p<0.05）。腹腔镜手术患者的住院时间较短（5.6对10天；p<0.05），术后麻醉药物使用较少，且开始耐受的时间较早（p<0.05）。腹腔镜手术出现1例严重并发症，开放手术出现2例。
我院165例UC患者中，32例接受了手术。腹腔镜手术似乎可行且安全。单阶段手术方法（第1组+第2组）对大多数患者仍然是最合理的选择。一期手术仅在特定病例中进行（第3组）。在我们的研究中，腹腔镜结肠切除术、直肠切除术和回肠肛管贮袋术中观察到了腹腔镜手术的优点，如改善美观、缩短术后肠梗阻时间和住院时间。
