Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA,
Surg Endosc. 2013 Dec;27(12):4564-8. doi: 10.1007/s00464-013-3124-z. Epub 2013 Aug 17.
Laparoscopic surgery is associated with well-known benefits, one of which is earlier return of bowel function. Since the laparoscopic approach to colon resections was introduced in the early 1990s, it has become the standard of care. Hand-assisted laparoscopic surgery (HALS) is a surgical approach in which dissection is facilitated by the surgeon's hand within the abdominal cavity during laparoscopy. The purpose of this study was to compare the incidence of postoperative ileus and the need for nasogastric tube (NGT) decompression in patients undergoing elective colon resections.
Following institutional review board approval, we performed a retrospective review of a prospectively collected database. Included were patients who underwent elective left-sided large bowel resections between 2009 and 2012. Exclusion criteria were urgent operation, stoma creation, ASA IV classification, NGT left in place at the end of surgery, and postoperative anastomotic leakage. Patients were divided into three groups: laparoscopic surgery, HALS, and open surgery. We evaluated the incidence of postoperative ileus and the use of nasogastric decompression in each group.
A total of 243 patients were included in this study; 73 patients underwent open surgery, 89 patients underwent HALS, and 81 patients underwent laparoscopic surgery. The proportion of patients who needed postoperative nasogastric decompression was significantly reduced in patients undergoing laparoscopic surgery (3.7%) or HALS (4.5%) compared with those who underwent open resection (17.8%). The time from surgery to first flatus and first bowel movement, the time to tolerate solid diet, and the total length of postoperative hospital stay also were all significantly reduced in the laparoscopic and HALS groups compared with the open surgery group. There were no significant differences in any of these measures between the laparoscopic group and the hand-assisted group.
Like laparoscopy, HALS is associated with less postoperative ileus and necessitates less NGT decompression than does open surgery.
腹腔镜手术具有众所周知的优势，其中之一是肠功能更早恢复。自 20 世纪 90 年代初引入腹腔镜结肠切除术以来，它已成为护理标准。手助腹腔镜手术（HALS）是一种手术方法，在腹腔镜检查期间，外科医生的手在腹腔内辅助进行解剖。本研究的目的是比较接受择期结肠切除术的患者术后肠梗阻的发生率和需要鼻胃管（NGT）减压的情况。
在获得机构审查委员会批准后，我们对前瞻性收集的数据库进行了回顾性分析。纳入 2009 年至 2012 年期间接受择期左半大肠切除术的患者。排除标准为紧急手术、造口术、ASA IV 分类、手术结束时 NGT 留置、术后吻合口漏。患者分为三组：腹腔镜手术、HALS 和开放手术。我们评估了每组患者术后肠梗阻的发生率和使用鼻胃减压的情况。
本研究共纳入 243 例患者；73 例患者接受开放手术，89 例患者接受 HALS，81 例患者接受腹腔镜手术。与接受开放切除的患者（17.8%）相比，接受腹腔镜手术（3.7%）或 HALS（4.5%）的患者需要术后鼻胃减压的比例显著降低。与开放手术组相比，腹腔镜组和 HALS 组患者的首次排气和首次排便时间、耐受固体饮食的时间以及术后住院总时间均显著缩短。这些措施在腹腔镜组和手助组之间没有显著差异。
与腹腔镜手术一样，HALS 与术后肠梗阻发生率较低和需要较少的 NGT 减压有关，而与开放手术相比。
