Department of Colorectal Surgery, University of California, Irvine School of Medicine, 333 City Blvd. West Suite 850, Orange, CA 92868, USA.
J Gastrointest Surg. 2013 Feb;17(2):382-91. doi: 10.1007/s11605-012-2096-y. Epub 2012 Dec 1.
Due to safety concerns, the use of laparoscopy in high-risk colorectal surgery patients has been limited. Small reports have demonstrated the benefit of laparoscopy in this population; however, large comparative studies are lacking.
A retrospective review of the Nationwide Inpatient Sample 2009 was conducted. Patients undergoing elective colorectal resections for benign and malignant pathology were included in the high-risk group if they had at least two of the following criteria: age > 70, obesity, smoking, anemia, congestive heart failure, valvular disease, diabetes mellitus, chronic pulmonary, kidney and liver disease. Using multivariate logistic regression, the outcomes of laparoscopic surgery were compared to open and converted surgery.
Of 145,600 colorectal surgery cases, 32.79% were high-risk. High-risk patients had higher mortality, hospital charges, and longer hospital stay compared to low-risk patients. The use of laparoscopy was lower in the high-risk group with higher conversion rates. In high-risk patients, compared to open surgery, laparoscopy was associated with lower mortality (OR = 0.60), shorter hospital stay, lower charges, decreased respiratory failure (OR = 0.53), urinary tract infection (OR = 0.64), anastomotic leak (OR = 0.69) and wound complications (OR = 0.46). Conversion to open surgery was not associated with higher mortality.
Laparoscopy in high-risk colorectal patients is safe and may demonstrate advantages compared to open surgery.
由于安全方面的考虑，腹腔镜在高危结直肠手术患者中的应用受到限制。一些小型报告已经证明了腹腔镜在这一人群中的益处，但缺乏大规模的对照研究。
对 2009 年全国住院患者样本进行了回顾性分析。如果患者具有以下至少两个标准，则将其纳入高危组：年龄>70 岁、肥胖、吸烟、贫血、充血性心力衰竭、瓣膜疾病、糖尿病、慢性肺部、肾脏和肝脏疾病。通过多变量逻辑回归，比较了腹腔镜手术与开放手术和中转手术的结果。
在 145600 例结直肠手术病例中，32.79%为高危病例。与低危患者相比，高危患者的死亡率、住院费用和住院时间更长。高危组腹腔镜的使用率较低，中转率较高。在高危患者中，与开放手术相比，腹腔镜手术的死亡率较低（OR=0.60），住院时间更短，费用更低，呼吸衰竭（OR=0.53）、尿路感染（OR=0.64）、吻合口漏（OR=0.69）和伤口并发症（OR=0.46）的发生率也更低。中转开放手术与更高的死亡率无关。
在高危结直肠患者中，腹腔镜手术是安全的，并且与开放手术相比可能具有优势。
