Sheth Jigna, Jaffray Bruce
Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, UK.
Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, UK.
J Pediatr Surg. 2014 Feb;49(2):262-4; discussion 264. doi: 10.1016/j.jpedsurg.2013.11.034. Epub 2013 Nov 15.
Restorative proctocolectomy (RP) is the gold standard for children requiring removal of their colon and rectum. The aim of this study is to contrast conventional (open) and laparoscopic RP.
All children undergoing RP by one surgeon were prospectively recorded in a customised database. Outcome variables were length of stay in days (LOS), duration of surgery in minutes (DS), blood loss in ml, and complications. Explanatory variables included technique of resection (open or laparoscopic (lap)) and presenting disease. Lap resection was adopted after patient 37. Data are presented as median (range). P<0.05 was regarded as significant.
Eighty-two (43 girls) children underwent RP at median age 12 (0.5-20) years. RP was performed as Open (n=37) or Laparoscopic (n=45). Indications were: colitis (n=56), polyposis (n=12), constipation (n=7), Hirschsprung's (n=5), fibrosing colonopathy (n=2). Significantly, more children had three-stage surgery among the lap group (P =0.04). LOS was significantly shorter in the lap group [15 (8-114) days vs 17(13- 60) days; P=0.04], but there was no difference in DS or complication rates between laparoscopic and open surgery. Laparoscopic surgery was associated with significantly lower blood loss [150 (0-840) ml vs. 334 (0-1480) ml; P=0.02].
Laparoscopic RP is associated with lower blood loss, shorter LOS, but no difference in duration of surgery or complication rate.
对于需要切除结肠和直肠的儿童，根治性直肠结肠切除术（RP）是金标准。本研究的目的是对比传统（开放）根治性直肠结肠切除术和腹腔镜根治性直肠结肠切除术。
由一名外科医生实施根治性直肠结肠切除术的所有儿童均被前瞻性地记录在一个定制数据库中。结果变量包括住院天数（LOS）、手术时长（以分钟计，DS）、失血量（以毫升计）和并发症。解释变量包括切除技术（开放或腹腔镜（lap））和所患疾病。第37例患者之后采用腹腔镜切除术。数据以中位数（范围）表示。P<0.05被视为具有显著性。
82例（43例女孩）儿童接受了根治性直肠结肠切除术，中位年龄为12（0.5 - 20）岁。根治性直肠结肠切除术采用开放手术（n = 37）或腹腔镜手术（n = 45）。适应证包括：结肠炎（n = 56）、息肉病（n = 12）、便秘（n = 7）、先天性巨结肠（n = 5）、纤维性结肠病（n = 2）。值得注意的是，腹腔镜组中接受三阶段手术的儿童更多（P = 0.04）。腹腔镜组的住院天数显著更短[15（8 - 114）天 vs 17（13 - 60）天；P = 0.04]，但腹腔镜手术和开放手术在手术时长或并发症发生率方面没有差异。腹腔镜手术的失血量显著更低[150（0 - 840）毫升 vs. 334（0 - 1480）毫升；P = 0.02]。
腹腔镜根治性直肠结肠切除术与更低的失血量、更短的住院天数相关，但在手术时长或并发症发生率方面没有差异。
