St Mark's Hospital, Harrow, UK.
Colorectal Dis. 2012 Apr;14(4):458-62. doi: 10.1111/j.1463-1318.2011.02683.x.
Familial adenomatous polyposis (FAP) is associated with an almost 100% chance of colorectal cancer by the age of 50 years. Surgery is the only prophylaxis. The study compared the outcome of prophylactic laparoscopic colectomy and ileorectal anastomosis (IRA) with conventional open surgery.
A case-control study was carried out including all cases of proven FAP undergoing prophylactic laparoscopic colectomy with IRA between 1 April 2006 and 31 March 2008 using a standardized technique within an enhanced recovery programme (ERAS). All data were collected prospectively. Controls were identified retrospectively from patients who underwent open prophylactic IRA before 31 March 2008 and were matched for age, gender, BMI and ASA. Outcomes included duration of surgery, complications, length of stay, readmission and mortality.
During the study period 25 patients underwent laparoscopic IRA. The median operating time was longer in the laparoscopic group (235 vs 180 mins, P < 0.0001) but the median hospital stay was shorter (6 vs 9 days, P = 0.002). Overall there were fewer complications in the laparoscopic group (20%vs 40%, P = 0.3).
Laparoscopic prophylactic colectomy with IRA in FAP is safe and feasible, and combined with ERAS leads to accelerated recovery and possibly fewer complications than open surgery. FAP patients undergoing prophylactic IRA should be offered laparoscopic surgery.
家族性腺瘤性息肉病（FAP）患者在 50 岁之前几乎 100%会发生结直肠癌。手术是唯一的预防措施。本研究比较了预防性腹腔镜结肠切除术和回肠直肠吻合术（IRA）与传统开腹手术的结果。
本研究采用病例对照研究，纳入了 2006 年 4 月 1 日至 2008 年 3 月 31 日期间采用标准化技术在强化康复方案（ERAS）下进行预防性腹腔镜结肠切除术和 IRA 的所有 FAP 患者。所有数据均前瞻性收集。对照组为 2008 年 3 月 31 日前接受开腹预防性 IRA 的患者，按照年龄、性别、BMI 和 ASA 进行匹配。结果包括手术时间、并发症、住院时间、再入院和死亡率。
在研究期间，有 25 例患者接受了腹腔镜 IRA。腹腔镜组的中位手术时间更长（235 分钟 vs 180 分钟，P < 0.0001），但中位住院时间更短（6 天 vs 9 天，P = 0.002）。总体而言，腹腔镜组的并发症发生率较低（20%vs 40%，P = 0.3）。
FAP 患者行预防性 IRA 的腹腔镜结肠切除术安全可行，与 ERAS 联合应用可加速康复，并可能比开腹手术并发症更少。应向接受预防性 IRA 的 FAP 患者提供腹腔镜手术。
