Division of Colorectal Surgery, Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York 14642, USA.
Colorectal Dis. 2012 May;14(5):572-7. doi: 10.1111/j.1463-1318.2011.02756.x.
Studies to date examining the impact of laparoscopy in resection for Crohn's disease on short-term morbidity have been limited by small study populations. The aim of this study was to establish the impact of the operative approach (laparoscopic or open) on outcomes after ileocolic resection for Crohn's disease.
Ileocolic resections for Crohn's disease were identified using Current Procedural Terminology (CPT) and International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes from the National Surgical Quality Improvement Program (NSQIP) database (2005-2009). Complications were categorized as major (organ system damage and systemic sepsis) or minor (incisional and urinary infections). Multivariate 30-day outcomes and length of stay were determined using linear models adjusting for patient characteristics, comorbidities and operative approach.
Of 1917 ileocolic resections, 644 (34%) were performed laparoscopically. At baseline, the open group was significantly older, had more comorbidities, higher American Society of Anesthesiology (ASA) classes, and more intra-operative transfusions (all variables, P<0.05). On multivariate analysis, laparoscopic ileocolic resections were associated with a decrease in major (OR=0.629, 95% CI: 0.430-0.905, P=0.014) and minor (OR=0.576, 95% CI: 0.405-0.804, P=0.002) complications compared with open resections. Laparoscopy was associated with a significant reduction in adjusted length of stay compared with the open approach (-1.08±0.29 days, P=0.0002).
After adjusting for comorbidities and perioperative factors, such as preoperative sepsis, higher ASA class and higher transfusion rates in the open group, laparoscopic ileocolic resection for Crohn's disease was found to be a safer choice than the open approach, resulting in fewer complications and length of stay. All other things being equal, such patients should be offered the laparoscopic approach as a first-choice option.
迄今为止，研究腹腔镜在克罗恩病切除术中对短期发病率的影响的研究受到小样本量的限制。本研究的目的是确定手术方法（腹腔镜或开放）对克罗恩病回肠结肠切除术的结果的影响。
使用国家手术质量改进计划（NSQIP）数据库（2005-2009 年）的当前程序术语（CPT）和国际疾病分类，第九修订版，临床修正（ICD-9-CM）代码，确定克罗恩病的回肠结肠切除术。并发症分为主要（器官系统损伤和全身败血症）或次要（切口和尿路感染）。使用线性模型调整患者特征、合并症和手术方法，确定 30 天的多变量结果和住院时间。
在 1917 例回肠结肠切除术中，644 例（34%）为腹腔镜手术。在基线时，开放组年龄较大，合并症较多，美国麻醉医师协会（ASA）分级较高，术中输血较多（所有变量，P<0.05）。多变量分析显示，与开放手术相比，腹腔镜回肠结肠切除术与主要（OR=0.629，95%CI：0.430-0.905，P=0.014）和次要（OR=0.576，95%CI：0.405-0.804，P=0.002）并发症减少相关。与开放方法相比，腹腔镜与调整后的住院时间明显缩短（-1.08±0.29 天，P=0.0002）。
在调整合并症和围手术期因素（如术前败血症、开放组较高的 ASA 分级和较高的输血率）后，腹腔镜回肠结肠切除术治疗克罗恩病被发现是一种比开放方法更安全的选择，从而减少并发症和住院时间。在其他条件相同的情况下，应将这种方法作为首选提供给此类患者。
