腹腔镜方法在克罗恩病复杂肠内脏瘘中是可行的：一项病例匹配回顾。

Laparoscopic approach is feasible in Crohn's complex enterovisceral fistulas: a case-match review.

机构信息

Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France.

出版信息

Dis Colon Rectum. 2013 Feb;56(2):191-7. doi: 10.1097/DCR.0b013e31826fedeb.

DOI:10.1097/DCR.0b013e31826fedeb

PMID:23303147

Abstract

BACKGROUND

Complex enterovisceral fistulas are internal fistulas joining a "diseased" organ to any intra-abdominal "victim" organ, with the exception of ileoileal fistulas. Few publications have addressed laparoscopic surgery for complex fistulas in Crohn's disease.

OBJECTIVE

The aim of this study was to evaluate the feasibility of such an approach.

DESIGN

This study is a retrospective, case-match review.

SETTINGS

This study was conducted at a tertiary academic hospital.

PATIENTS

: All patients who underwent a laparoscopic ileocecal resection for complex enterovisceral fistulas between January 2004 and August 2011 were included. They were matched to a control group undergoing operation for nonfistulizing Crohn's disease according to age, sex, nutritional state, preoperative use of steroids, and type of resection performed. Matching was performed blind to the peri- and postoperative results of each patient.

MAIN OUTCOME MEASURES

The 2 groups were compared in terms of operative time, conversion to open surgery, morbidity and mortality rates, and length of stay.

RESULTS

Eleven patients presenting with 13 complex fistulas were included and matched with 22 controls. Group 1 contained 5 ileosigmoid fistulas (38%), 3 ileotransverse fistulas (23%), 3 ileovesical fistulas (23%), 1 colocolic fistula (8%), and 1 ileosalpingeal fistula (8%). There were no significant differences between the groups in terms of operative time (120 (range, 75-270) vs 120 (range, 50-160) minutes, p = 0.65), conversion to open surgery (9% vs 0%, p = 0.33), stoma creation (9% vs 14%, p = 1), global postoperative morbidity (18% vs 32%, p = 0.68), and major complications (Dindo III: 0% vs 9%, p = 0.54; Dindo IV: 0% vs 0%, p = 1), as well as in terms of length of stay (8 (range, 7-32) vs 9 (range, 5-17) days, p = 0.72). No patients died.

LIMITATIONS

This is a retrospective review with a small sample size.

CONCLUSION

A laparoscopic approach for complex fistulas is feasible in Crohn's disease, with outcomes similar to those reported for nonfistulizing forms.

摘要

背景

复杂的肠内内脏瘘是将“患病”器官与任何腹腔内“受害”器官连接起来的内瘘，除回肠-回肠瘘外。很少有文献报道腹腔镜手术治疗克罗恩病的复杂瘘。

目的

本研究旨在评估这种方法的可行性。

设计

这是一项回顾性病例匹配研究。

设置

本研究在一家三级学术医院进行。

患者

所有 2004 年 1 月至 2011 年 8 月期间因复杂肠内内脏瘘而行腹腔镜回盲部切除术的患者均被纳入研究。他们与因非瘘管性克罗恩病而行手术的对照组患者按照年龄、性别、营养状况、术前使用类固醇和进行的切除术类型进行匹配。匹配是在对每个患者的围手术期结果进行盲法的情况下进行的。

主要观察指标

比较两组患者的手术时间、中转开腹率、发病率和死亡率以及住院时间。

结果

共纳入 11 例 13 例复杂瘘患者，与 22 例对照组患者进行了匹配。第 1 组包括 5 例回-乙状结肠瘘（38%）、3 例回-横结肠瘘（23%）、3 例回-膀胱瘘（23%）、1 例结肠-结肠瘘（8%）和 1 例回-输卵管瘘（8%）。两组患者的手术时间（120（范围，75-270）vs 120（范围，50-160）min，p=0.65）、中转开腹率（9%vs 0%，p=0.33）、造口术（9%vs 14%，p=1）、总体术后发病率（18%vs 32%，p=0.68）和主要并发症（Dindo III：0%vs 9%，p=0.54；Dindo IV：0%vs 0%，p=1）差异均无统计学意义，住院时间也无差异（8（范围，7-32）vs 9（范围，5-17）d，p=0.72）。无患者死亡。