Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands; Department of Gastroenterology, Academic Medical Center, Amsterdam, the Netherlands.
J Crohns Colitis. 2013 Nov;7(10):e443-8. doi: 10.1016/j.crohns.2013.02.015. Epub 2013 Mar 16.
Several case series have demonstrated the feasibility of single-port laparoscopic ileocecal resection in Crohn's disease. However, only a few studies compared the single-port with a multiport laparoscopic ileocecal approach. The aim of this study was to compare short term surgical outcome parameters between single-port and multiport laparoscopic ileocecal resections for Crohn's disease.
Twenty-one patients who underwent single-port laparoscopic ileocecal resection between March 2010 and September 2012 were prospectively registered. A matched comparison on a 1:2 basis was performed with patients who underwent multiport laparoscopic ileocecal resection from January 1999 to March 2010. Matching parameters were BMI, length of diseased bowel resected and the presence of fistulas. Endpoints were the length of postoperative hospital stay, operative time, conversions, complications, postoperative pain scores and postoperative analgesia consumption.
Twenty-one patients undergoing single-port resection were matched to 42 patients undergoing multiport resection. The postoperative stay (4 days, iqr 4-5 vs. 5 days, iqr 4-6; p=0.033), operative time (103 min, iqr 94.0-121.0 vs. 123.5 min, iqr 100.0-157.0; p=0.036) and morphine use on the first postoperative day (12.5 mg, iqr 5.0-33.3 vs. 28 mg, 15.0-50.0; p=0.012) differed significantly. Postoperative pain scores and complications were similar in both groups. This study was limited by potential selection bias.
Single-port laparoscopic ileocecal resection is safe and feasible in Crohn's disease and is associated with less need for pain medication postoperatively as opposed to multiport laparoscopic ileocecal resection.
几项病例系列研究已经证明，单孔腹腔镜回盲部切除术在克罗恩病中是可行的。然而，仅有少数研究比较了单孔与多孔腹腔镜回盲部切除术。本研究旨在比较单孔与多孔腹腔镜回盲部切除术治疗克罗恩病的短期手术结果参数。
前瞻性登记了 2010 年 3 月至 2012 年 9 月期间行单孔腹腔镜回盲部切除术的 21 例患者。按照 BMI、切除的病变肠段长度和瘘管的存在进行 1:2 配对，与 1999 年 1 月至 2010 年 3 月行多孔腹腔镜回盲部切除术的患者进行匹配比较。终点为术后住院时间、手术时间、中转开腹、并发症、术后疼痛评分和术后镇痛药物使用。
21 例单孔组患者与 42 例多孔组患者进行了匹配。单孔组的术后住院时间（4 天，四分位距 4-5 比 5 天，四分位距 4-6；p=0.033）、手术时间（103 分钟，四分位距 94.0-121.0 比 123.5 分钟，四分位距 100.0-157.0；p=0.036）和术后第一天吗啡用量（12.5 毫克，四分位距 5.0-33.3 比 28 毫克，四分位距 15.0-50.0；p=0.012）差异显著。两组术后疼痛评分和并发症相似。本研究受到潜在选择偏倚的限制。
单孔腹腔镜回盲部切除术在克罗恩病中是安全可行的，与多孔腹腔镜回盲部切除术相比，术后需要的镇痛药物更少。
