Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France.
Dig Liver Dis. 2012 Feb;44(2):118-22. doi: 10.1016/j.dld.2011.09.007. Epub 2011 Oct 20.
Restorative proctocolectomy performed before the advent of laparoscopy had evolved to frequently omit a diverting stoma. Our aim was to assess the impact of a diverting stoma on postoperative outcomes following laparoscopic restorative proctocolectomy.
Data on all patients undergoing a laparoscopic restorative proctocolectomy at our institution were prospectively collated in a database.
Between November 2004 and February 2010, 71 patients (38 females) underwent laparoscopic restorative proctocolectomy. Indications included familial adenomatous polyposis (n=34), ulcerative colitis (n=35), indeterminate colitis (n=1) and Lynch syndrome (n=1). Laparoscopic restorative proctocolectomy was performed as a one-stage procedure in 49 patients, and after a sub-total colectomy in 22. Seven patients in each group underwent the formation of a diverting stoma. Nine patients required conversion to open surgery. Sixteen patients experienced at least one postoperative complication. The postoperative morbidity was 29% (n=4/14) and 21% (n=12/21) in patients with and without a stoma (p=0.8), and the rate of fistula was 21% and 5%, respectively (p=0.08). Seven percent of patients with a stoma and 16% without stoma had an intra-abdominal collection (p=0.7). Nine patients required reoperation. The reoperation rate was not influenced by the presence or absence of a diverting stoma.
Laparoscopic restorative proctocolectomy can be performed safely without a diverting stoma in selected patients.
在腹腔镜出现之前进行的修复性直肠结肠切除术经常省略转流造口术。我们的目的是评估转流造口术对腹腔镜修复性直肠结肠切除术后术后结果的影响。
我们在一个数据库中前瞻性地收集了我院所有接受腹腔镜修复性直肠结肠切除术的患者的数据。
2004 年 11 月至 2010 年 2 月，71 例患者（38 名女性）接受了腹腔镜修复性直肠结肠切除术。适应证包括家族性腺瘤性息肉病（n=34）、溃疡性结肠炎（n=35）、不确定结肠炎（n=1）和林奇综合征（n=1）。49 例患者行腹腔镜一期直肠结肠切除术，22 例患者行次全结肠切除术。每组有 7 例患者行转流造口术。9 例患者需要转为开腹手术。16 例患者至少发生 1 次术后并发症。有造口术的患者术后发病率为 29%（n=4/14），无造口术的患者为 21%（n=12/21）（p=0.8），瘘管发生率分别为 21%和 5%（p=0.08）。有造口术的患者中有 7%和无造口术的患者中有 16%发生腹腔脓肿（p=0.7）。9 例患者需要再次手术。再次手术率不受转流造口术的影响。
在选择的患者中，腹腔镜修复性直肠结肠切除术可以安全地进行，无需转流造口术。
