Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Inflamm Bowel Dis. 2010 Nov;16(11):1940-6. doi: 10.1002/ibd.21265.
Minimally invasive surgery for Crohn's ileocolitis is well established but few data exist regarding laparoscopic techniques for Crohn's colitis. We aimed to describe outcomes associated with minimally invasive surgery for Crohn's colitis, including predictors of conversion to laparotomy and postoperative complications.
We identified all Crohn's patients who underwent minimal invasive colectomy at our institution from 1997-2008. Data represent frequency (proportion) or median (interquartile range). Multivariate regression identified factors associated with conversion and 30-day complications (odds ratio [95% confidence interval]).
Over 11 years we identified 92 patients, median age 40 (26-51) years, body mass index (BMI) 22.9 (19.3-26.4) kg/m(2); 61% were women. Median Crohn's duration was 6.5 (4-15) years, 11% had prior intestinal resection; medications included immunomodulators (62%), corticosteroids (54%), infliximab (35%). Forty-three cases (47%) were total colectomy, 17 (18%) subtotal colectomy, 32 (35%) were segmental. Straight laparoscopy was used in 57%; 43% were hand-assisted. Median operative time was 248 (190-292) minutes. There were 15 (16%) conversions; only small bowel disease predicted conversion (OR 7 [1.6-35]). Conversion was not associated with increased length of stay or with postoperative complications. Overall postoperative length of stay was 5 (4-7) days. Short-term complications occurred in 34% with reoperation in 5: obstruction n = 3, anastomotic leak n = 2. Only perianal disease predicted complications (2.6 [1.0-6.6]). There was no 30-day mortality.
Minimally invasive colectomy in patients with Crohn's colitis can be safely accomplished with reasonable operative times, conversion rates, and excellent postoperative outcomes.
微创外科治疗克罗恩病性回结肠炎已得到广泛认可，但关于克罗恩病性结肠炎的腹腔镜技术的数据却很少。我们旨在描述与克罗恩病性结肠炎的微创外科相关的结果，包括转化为剖腹手术和术后并发症的预测因素。
我们从 1997 年至 2008 年确定了在我院接受微创结肠切除术的所有克罗恩病患者。数据表示频率（比例）或中位数（四分位距）。多元回归分析确定了与转化和 30 天并发症相关的因素（比值比[95％置信区间]）。
在 11 年期间，我们共确定了 92 例患者，中位年龄为 40（26-51）岁，体重指数（BMI）为 22.9（19.3-26.4）kg/m2；61％为女性。克罗恩病的中位病程为 6.5（4-15）年，11％有过肠道切除术；药物治疗包括免疫调节剂（62％），皮质类固醇（54％），英夫利昔单抗（35％）。43 例（47％）为全结肠切除术，17 例（18％）为次全结肠切除术，32 例（35％）为节段性切除术。57％采用直线腹腔镜检查，43％为手动辅助。中位手术时间为 248（190-292）分钟。有 15 例（16％）发生转化；仅小肠疾病预测转化（OR 7 [1.6-35]）。转化与住院时间延长或术后并发症无关。总体术后住院时间为 5（4-7）天。短期并发症发生率为 34％，5 例需要再次手术：梗阻 3 例，吻合口漏 2 例。仅肛周疾病预测并发症（2.6 [1.0-6.6]）。无 30 天死亡率。
对于克罗恩病性结肠炎患者，微创结肠切除术可安全完成，手术时间、转化率和术后结果均良好。
