Department of Colorectal Surgery, Frenchay Hospital, Bristol, UK.
Colorectal Dis. 2011 Dec;13(12):1413-6. doi: 10.1111/j.1463-1318.2010.02511.x.
The safety and short-term outcome of laparoscopic surgery for recurrent ileocolic Crohn's disease was compared with the outcome following primary resection.
Between June 2002 and June 2010, 59 consecutive unselected patients (30 of whom had recurrent disease) underwent laparoscopic ileocolic resection. Four primary resections and one revision were performed as a single incision laparoscopic surgery (SILS) procedure.
There was no difference between the two groups in terms of age, body mass index, American Society of Anesthesiology (ASA) grade or the presence or absence of fistulating disease. The median operating time was significantly longer for the revision group (125 min vs 85 min; P < 0.001). The rate of conversion was 8.5%, morbidity was 20% and mortality was 0% (P = not significant between groups). Risk factors for conversion included a complex fistula, fibrosis and the need to carry out multiple stricturoplasty. Patients in whom surgery was converted had a longer hospital stay and a higher morbidity (40%). The median hospital stay was 3 days, the return to theatre rate was 5% and the re-admission rate was 5% (P = not significant between groups).
Laparoscopic surgery for recurrent ileocolic Crohn's disease is safe and can lead to significant short-term benefit, including earlier discharge. Conversion increases the length of stay in hospital and the overall morbidity.
比较腹腔镜手术治疗复发性回结肠克罗恩病与初次切除的安全性和短期结果。
2002 年 6 月至 2010 年 6 月，59 例连续未经选择的患者（其中 30 例为复发性疾病）接受了腹腔镜回结肠切除术。4 例初次切除和 1 例修正术采用单切口腹腔镜手术（SILS）进行。
两组在年龄、体重指数、美国麻醉医师协会（ASA）分级、有无瘘管病方面无差异。修正组的中位手术时间明显较长（125 分钟比 85 分钟；P<0.001）。转化率为 8.5%，发病率为 20%，死亡率为 0%（组间无统计学差异）。转化率的危险因素包括复杂的瘘管、纤维化和需要多次狭窄成形术。手术转换的患者住院时间更长，发病率更高（40%）。中位住院时间为 3 天，再次手术率为 5%，再入院率为 5%（组间无统计学差异）。
腹腔镜手术治疗复发性回结肠克罗恩病是安全的，可以带来显著的短期益处，包括更早出院。转换会增加住院时间和总发病率。
