Department of Colorectal Surgery, Frenchay Hospital, Bristol, UK.
Surg Endosc. 2011 Dec;25(12):3877-80. doi: 10.1007/s00464-011-1814-y. Epub 2011 Jul 15.
Restorative proctocolectomy with ileoanal pouch is the definitive procedure in ulcerative colitis. The potential benefits afforded by a single incision laparoscopic (SILS) approach make it appropriate to consider.
Electronic data were prospectively collected from all patients who underwent SILS restorative proctocolectomy (SILS-RPC) between June 2009 and June 2010.
Ten consecutive patients (4 male), with median BMI = 22 (range = 20-28 kg/m(2)) underwent SILS-LRPC over a 1-year period. Three had undergone a previous emergency laparoscopic colectomy. A single-port device (Covidien SILS™ or Olympus TriPort™) was positioned at the site of the existing or proposed temporary ileostomy (2.5-cm incision). The colon and rectum were extracted through the SILS site (n = 8) or transanally following a mucosectomy (n = 2). A 20-cm J pouch was constructed extracorporeally and returned via the ileostomy site. Pouch-anal anastomosis was performed intracorporeally (n = 8) or hand-sutured (n = 2) and a diverting loop ileostomy was created at the SILS port site. The median operation time was 185 min (range = 100-381). There were no conversions or additional ports required. Median time to full diet was 36 h (range = 4-48 h) with a median hospital stay of 3 days (range = 2-8 days). There were no 30-day readmissions. Complications included surgical emphysema with temperature and a panic attack. Nine stomas have been closed. All patients have spontaneity of defecation, with a median pouch frequency of four per day, including once at night. All are fully continent and able to defer during the day. One reported a dry ejaculate for 10 weeks.
SILS restorative proctocolectomy is safe with good early functional outcomes when performed by an experienced laparoscopic surgeon.
回肠贮袋肛管吻合术是溃疡性结肠炎的确定性治疗方法。单切口腹腔镜（SILS）方法具有潜在的优势，因此值得考虑。
电子数据前瞻性地收集了 2009 年 6 月至 2010 年 6 月期间接受 SILS 直肠结肠切除术（SILS-RPC）的所有患者。
10 例连续患者（4 例男性），中位 BMI = 22（范围= 20-28kg/m2），在 1 年内接受 SILS-LRPC。其中 3 例曾行紧急腹腔镜结肠切除术。单孔装置（Covidien SILS™或 Olympus TriPort™）置于现有的或拟议的临时性回肠造口部位（2.5cm 切口）。结肠和直肠通过 SILS 部位提取（n=8）或经肛门行黏膜切除术（n=2）。20cm 的 J 型贮袋在体外构建，通过回肠造口部位返回。贮袋-肛门吻合术在体内进行（n=8）或手工缝合（n=2），并在 SILS 端口部位创建预防性回肠造口术。中位手术时间为 185 分钟（范围=100-381 分钟）。无中转或额外的端口需要。中位完全饮食时间为 36 小时（范围=4-48 小时），中位住院时间为 3 天（范围=2-8 天）。无 30 天内再入院。并发症包括手术性气肿伴发热和惊恐发作。9 例造口关闭。所有患者均能自主排便，每日平均 4 次，包括夜间 1 次。所有患者均完全有控制能力，并能在白天忍住。1 例报告 10 周内出现干燥精液。
SILS 直肠结肠切除术由经验丰富的腹腔镜外科医生进行时是安全的，早期功能结果良好。
