Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK
Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK.
Gastroenterol Rep (Oxf). 2014 Nov;2(4):251-61. doi: 10.1093/gastro/gou053. Epub 2014 Aug 21.
To review the published studies reporting various specimen retrieval incisions being used by colorectal surgeons in patients undergoing laparoscopic colorectal resections (LCR).
Standard medical electronic databases were searched to find relevant articles and a summary conclusion was generated.
There were 43 studies reporting various approaches used for the purpose of specimen retrieval in 2388 patients undergoing LCR. The most common approaches were periumbilical midline incision (1260 reported case in the literature), transverse incision (583 reported cases in the literature) in the right- or left iliac fossa, depending on the side of colonic resection, and Pfannensteil incision (293 reported cases in the literature). Periumbilical midline incision was associated with the higher risk of developing incisional hernia (odds ratio 53.72; 95% confidence interval 7.48-386.04; Z = 3.96; P = 0.0001). In terms of surgical site infection (SSI), there was no difference between the three common approaches to specimen retrieval. Transanal and transvaginal approaches were associated with higher risk of SSI.
Midline, transverse and Pfannensteil incisions were the most commonly used approaches for specimen retrieval following LCR. Midline incision was associated with higher risk of incisional hernia. Risk of SSI was similar in all three common approaches. The transanal and transvaginal approaches pose a higher risk of SSI. These conclusions are based on the combined outcome of published case series, case reports and comparative studies. Randomized, controlled trials with longer follow-up are required before recommending the routine use of any approach for specimen retrieval in patients undergoing LCR.
回顾已发表的研究报告，这些研究报告介绍了行腹腔镜结直肠切除术（LCR）的结直肠外科医生使用的各种标本取出切口。
检索标准医学电子数据库以查找相关文章，并得出总结结论。
有 43 项研究报告了 2388 例接受 LCR 的患者中用于标本取出的各种方法。最常见的方法是脐中线切口（文献中报道了 1260 例病例），根据结肠切除的部位，在右或左髂窝行横向切口（文献中报道了 583 例病例），以及 Pfannensteil 切口（文献中报道了 293 例病例）。脐中线切口与切口疝的发生风险较高相关（优势比 53.72；95%置信区间 7.48-386.04；Z = 3.96；P = 0.0001）。就手术部位感染（SSI）而言，三种常见的标本取出方法之间没有差异。经肛门和经阴道入路与 SSI 风险增加相关。
LCR 后最常使用的标本取出方法是中线、横向和 Pfannensteil 切口。中线切口与切口疝的发生风险较高相关。所有三种常见方法的 SSI 风险相似。经肛门和经阴道入路会增加 SSI 的风险。这些结论是基于已发表的病例系列、病例报告和对照研究的综合结果。需要更长时间随访的随机对照试验，才能推荐在接受 LCR 的患者中常规使用任何一种方法进行标本取出。
