Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA.
Inflamm Bowel Dis. 2012 May;18(5):863-8. doi: 10.1002/ibd.21808. Epub 2011 Jul 14.
Inflammatory bowel disease (IBD) patients have a high incidence of wound and overall postoperative complications. A totally laparoscopic approach could potentially reduce these risks. We adopted totally laparoscopic total proctocolectomy (TL-TPC) using the perineal wound for extraction as the procedure of choice in IBD patients who are not candidates for a restorative procedure. This study looks at the TL-TPC results and compares them with our open cohort.
Prospectively collected data from 52 consecutive patients undergoing TL-TPC from 2002 to 2010 were compared to 31 contemporary patients undergoing open TPC.
Demographics and patient characteristics including body mass index were similar. Mean operative times were 340 ± 7 minutes for TL-TPC and 337 ± 9 minutes for open TPC (P = 0.91). Intraoperative blood loss was 228 ± 2 mL for TL-TPC and 484 ± 3 mL for open TPC (P < 0.001). Return of bowel function measured as an ileostomy output >100 mL per 8 hours occurred at 2.7 ± 2.8 days for TL-TPC versus 3.3 ± 1.8 days for open TPC (P = 0.025). The length of stay was 8.4 ± 5.0 days for TL-TPC versus 9.2 ± 3.2 days for open TPC (P = 0.05). The overall complication rate was 43% for TL-TPC versus 65% for open TPC (P = 0.07). Postoperative abdominal wound infections and parastomal hernias occurred in 23% and 10% of open TPC patients, respectively, versus zero (P = 0.001) and 6% (P = 0.67) for TL-TPC.
TL-TPC is therefore considered a safe alternative to open surgery for selected IBD patients not candidates for a restorative procedure.
炎症性肠病（IBD）患者的伤口和整体术后并发症发生率较高。完全腹腔镜方法可能会降低这些风险。我们采用经会阴切口提取的完全腹腔镜全结肠直肠切除术（TL-TPC）作为不适合恢复性手术的 IBD 患者的首选方法。本研究着眼于 TL-TPC 的结果，并将其与我们的开放队列进行比较。
前瞻性收集 2002 年至 2010 年期间 52 例连续接受 TL-TPC 的患者的数据，并与 31 例同期接受开放 TPC 的患者进行比较。
人口统计学和患者特征，包括体重指数，相似。TL-TPC 的平均手术时间为 340 ± 7 分钟，开放 TPC 为 337 ± 9 分钟（P = 0.91）。TL-TPC 的术中出血量为 228 ± 2 mL，开放 TPC 为 484 ± 3 mL（P < 0.001）。TL-TPC 的回肠造口输出量> 100 mL/8 小时的肠功能恢复时间为 2.7 ± 2.8 天，而开放 TPC 为 3.3 ± 1.8 天（P = 0.025）。TL-TPC 的住院时间为 8.4 ± 5.0 天，开放 TPC 为 9.2 ± 3.2 天（P = 0.05）。TL-TPC 的总并发症发生率为 43%，开放 TPC 为 65%（P = 0.07）。开放 TPC 患者的术后腹部伤口感染和造口旁疝发生率分别为 23%和 10%，而 TL-TPC 则分别为 0（P = 0.001）和 6%（P = 0.67）。
因此，TL-TPC 被认为是不适合恢复性手术的选定 IBD 患者的安全替代方法。
