Department of Surgery, Academic Medical Center, PO Box 22660, 1100, Amsterdam, The Netherlands.
Surg Endosc. 2012 Feb;26(2):368-73. doi: 10.1007/s00464-011-1880-1. Epub 2011 Oct 13.
The aim of this study was to determine whether the need for adhesiolysis during completion proctectomy (CP) with ileopouch anal anastomosis (IPAA) is influenced by the surgical approach of the initial emergency colectomy for ulcerative colitis and the hospital setting.
One hundred consecutive patients who underwent CP with IPAA in our center between January 1999 and April 2010 were included. Emergency colectomy had been performed laparoscopically in 30 of 52 patients at the Academic Medical Center Amsterdam and in 6 of 48 patients at referring hospitals. Case files of these patients were retrospectively reviewed.
Significantly more extensive adhesiolysis was performed after open compared to laparoscopic colectomy (47 vs. 6%, P < 0.001). In univariate analysis, emergency colectomy at a referring hospital was also predictive for adhesiolysis (P = 0.003), but the open approach for the initial colectomy was the only independent predictive factor for the need for adhesiolysis (P < 0.001) in a multivariable ordinal logistic regression analysis. Operating time of CP was significantly longer when limited [18 (95% CI = 0-36) min] or extensive [55 (35-75) min] adhesiolysis had to be performed. The interval to CP was longer after open colectomy and after colectomy performed at a referring hospital. Significantly more incisional hernia corrections during CP were performed after open emergency colectomy (14 vs. 0%, P = 0.024). Overall morbidity and postoperative hospital stay of CP were not related to the surgical approach or the hospital setting of the emergency colectomy.
Laparoscopic as opposed to open emergency colectomy is associated with less adhesiolysis, fewer incisional hernias, and a shorter interval to completion proctectomy.
本研究旨在确定在经肛门直肠切除吻合术（IPAA）完成直肠切除术中是否需要粘连松解，这是否受溃疡性结肠炎初始急诊结肠切除术的手术方法和医院环境的影响。
纳入了 1999 年 1 月至 2010 年 4 月期间在我院接受 IPAA 完成直肠切除术的 100 例连续患者。在阿姆斯特丹学术医疗中心，52 例患者中有 30 例采用腹腔镜进行了紧急结肠切除术，在转诊医院中，48 例患者中有 6 例采用腹腔镜进行了紧急结肠切除术。回顾性分析这些患者的病例资料。
与腹腔镜结肠切除术相比，开放性结肠切除术需要进行更广泛的粘连松解（47% vs. 6%，P<0.001）。单因素分析显示，在转诊医院进行的紧急结肠切除术也是粘连松解的预测因素（P=0.003），但在多变量有序逻辑回归分析中，开放性初始结肠切除术是需要粘连松解的唯一独立预测因素（P<0.001）。当需要进行有限[18（95%CI=0-36）min]或广泛[55（35-75）min]粘连松解时，CP 的手术时间明显延长。开放性结肠切除术和转诊医院进行的结肠切除术，CP 的间隔时间更长。与开放性紧急结肠切除术相比，CP 期间进行了更多的切口疝修补术（14 例 vs. 0%，P=0.024）。总体并发症发生率和 CP 术后住院时间与手术方法或紧急结肠切除术的医院环境无关。
与开放性紧急结肠切除术相比，腹腔镜紧急结肠切除术与较少的粘连松解、较少的切口疝和较短的 CP 间隔时间相关。
