West Penn Allegheny Health System, Pittsburgh, PA, USA.
Tech Coloproctol. 2011 Dec;15(4):397-401. doi: 10.1007/s10151-011-0756-7. Epub 2011 Sep 2.
Due to the recent heightened interest in even less invasive surgery, single port laparoscopic colorectal surgery is quickly gaining acceptance. While this access technique was first described in 2007 for colorectal resective procedures, large series are lacking.
Between January 2009 and October 2010, all patients undergoing single port colorectal surgery performed by a single surgeon were prospectively entered into an IRB-approved database and studied with regard to perioperative events, morbidity, and mortality.
One hundred and two consecutive patients underwent a single port colorectal procedure. Mean age was 47 years (9-93 years), and average body mass index was 26 kg/m(2) (15-39 kg/m(2)). Primary diagnoses included ulcerative colitis (51), neoplasia (23), Crohn's disease (14), diverticulitis (11), familial adenomatous polyposis (1), and other (2). Procedures included 23 total colectomies, 40 segmental colectomies, and 19 other procedures. There was 1 conversion to an open operation, and 18 (18%) patients required placement of additional ports (1 port: N = 13; 2 ports: N = 2; 3 ports: N = 3). Average operating room time was 99 min (13-245), mean length of incision was 3.7 cm (1.2-7.8 cm), and average estimated blood loss was 140 ml (0-750 ml). There was one postoperative death, and 39 (38%) patients experienced minor postoperative complications. Mean lymph node harvest for oncologic resections was 44 (14-142). The average length of hospital stay was 5.9 days (2-24 days).
With proper patient selection and laparoscopic experience, single port colorectal surgery can be performed for even the most complex colorectal procedures. Further studies are needed to assess the benefits that single port colorectal surgery has over a conventional laparoscopic approach.
由于最近对微创手术的兴趣日益浓厚，单孔腹腔镜结直肠手术迅速得到认可。虽然这种入路技术于 2007 年首次用于结直肠切除术，但缺乏大量的系列报道。
2009 年 1 月至 2010 年 10 月，所有由一位外科医生施行单孔结直肠手术的患者前瞻性地被纳入经机构审查委员会批准的数据库中，并对其围手术期事件、发病率和死亡率进行研究。
102 例连续患者接受了单孔结直肠手术。平均年龄为 47 岁（9-93 岁），平均体重指数为 26kg/m²（15-39kg/m²）。主要诊断包括溃疡性结肠炎（51 例）、肿瘤（23 例）、克罗恩病（14 例）、憩室炎（11 例）、家族性腺瘤性息肉病（1 例）和其他（2 例）。手术包括 23 例全结肠切除术、40 例节段性结肠切除术和 19 例其他手术。有 1 例中转开腹手术，18 例（18%）患者需要放置额外的端口（1 个端口：N=13；2 个端口：N=2；3 个端口：N=3）。平均手术室时间为 99min（13-245min），切口平均长度为 3.7cm（1.2-7.8cm），平均估计出血量为 140ml（0-750ml）。术后有 1 例死亡，39 例（38%）患者出现轻微术后并发症。肿瘤切除术的平均淋巴结清扫量为 44 个（14-142 个）。平均住院时间为 5.9 天（2-24 天）。
在适当的患者选择和腹腔镜经验的基础上，即使是最复杂的结直肠手术也可以施行单孔结直肠手术。需要进一步研究来评估单孔结直肠手术相对于传统腹腔镜方法的益处。
