Department of General Surgery, Royal Berkshire Hospital, Reading, UK.
Colorectal Dis. 2011 Oct;13(10):1153-7. doi: 10.1111/j.1463-1318.2010.02443.x.
Restorative proctocolectomy is the definitive procedure for ulcerative colitis. The potential benefits of a minimal invasive approach make it appropriate to consider this approach provided that there are no adverse effects. The aim of the present study was to report our experience of laparoscopic assisted and 'total' laparoscopic restorative proctocolectomy (LRPC) and to highlight the difficulties encountered and the functional results obtained.
Electronic data were prospectively collected from all patients who underwent laparoscopic restorative proctocolectomy (LRPC) from October 1999 to April 2010.
Seventy-two (40 male) patients [median body mass index 24 (19-48) kg/m(2) ] underwent LRPC over 10 years. Three had cancer. Forty-two had undergone a previous colectomy (laparoscopic in 38). There were 40 W- and 32 J-pouch reconstructions; seven were single-port procedures. The median operation time was 210 (75-330) min. There were five (7%) conversions, one of which resulted in immediate pouch failure. The median time to full diet was 36 (4-168) h, with a median hospital stay of 7 (2-64) days. There were seven (10%) readmissions. Complications were immediate (3%), early (22%) and long term (11%). The incidence of failure (excision or indefinite diversion) was 2.7%. The stoma has been closed in 67 patients. Median frequency of defaecation was 4/24 h, with normal continence in 90% and the ability to defer during the day in 98%. There was no new case of impotence or dyspareunia.
Laparoscopic restorative proctocolectomy is safe and gives good results when performed by an experienced laparoscopic surgeon.
直肠结肠切除术是溃疡性结肠炎的确定性治疗方法。微创方法的潜在益处使其成为一种合适的选择，前提是没有不良反应。本研究旨在报告我们腹腔镜辅助和“全”腹腔镜直肠结肠切除术（LRPC）的经验，并强调所遇到的困难和获得的功能结果。
从 1999 年 10 月至 2010 年 4 月，所有接受腹腔镜直肠结肠切除术（LRPC）的患者的电子数据均前瞻性收集。
10 年内，72 名（40 名男性）患者[中位数体重指数 24（19-48）kg/m2]接受了 LRPC。其中 3 例患有癌症。42 例曾接受过结肠切除术（38 例为腹腔镜）。有 40 例 W 型和 32 例 J 型袋重建；7 例为单端口手术。中位手术时间为 210（75-330）min。有 5 例（7%）中转开腹，其中 1 例导致即刻袋失败。完全进食的中位时间为 36（4-168）h，中位住院时间为 7（2-64）天。有 7 例（10%）再入院。并发症为即刻（3%）、早期（22%）和长期（11%）。切除或不确定引流的失败率为 2.7%。67 例患者已关闭造口。排便频率中位数为 4/24 h，90%有正常的控便能力，98%白天能控制排便。没有新的阳痿或性交困难病例。
当由经验丰富的腹腔镜外科医生进行时，腹腔镜直肠结肠切除术是安全的，并且效果良好。
