Messenger David E, Mihailovic Dana, MacRae Helen M, O'Connor Brenda I, Victor J Charles, McLeod Robin S
1Division of General Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada 2Zane Cohen Clinical Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada 3Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada 4Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada 5Department of Surgery, University of Toronto, Toronto, Ontario, Canada 6Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Dis Colon Rectum. 2014 Dec;57(12):1349-57. doi: 10.1097/DCR.0000000000000238.
Comparative outcome data for laparoscopic and open subtotal colectomy in IBD are lacking and often difficult to interpret owing to low case volumes, heterogeneity in case mix, and variation in laparoscopic technique.
This study aimed to determine the safety of laparoscopic subtotal colectomy in severe colitis and to determine whether the laparoscopic approach improved short-term outcomes in comparison with the open approach.
This was a retrospective cohort study using data from a prospectively maintained clinical database.
This study was conducted at a single center, Mount Sinai Hospital, Toronto.
All patients undergoing subtotal colectomy for either ulcerative or Crohn's colitis between 2000 and 2011 were included.
A standardized operative technique was used for both laparoscopic and open subtotal colectomies. Cases performed by non-laparoscopic surgeons were excluded.
Perioperative outcome measures were operative duration, estimated blood loss, total morphine requirement, and length of postoperative stay. Postoperative outcome measures were the rates of minor and major complications.
Laparoscopic subtotal colectomies were performed in 131 of 290 cases (45.2%). Nine patients required conversion to an open procedure (6.9%). The uptake of laparoscopic subtotal colectomy increased from 10.2% in 2000/2001 to 71.7% in 2010/2011. Regression analysis with propensity-score adjustment for operative approach revealed that the operative duration was 25.5 minutes longer in laparoscopic cases (95% CI 12.3-38.6; p < 0.001), but that patients experienced fewer minor complications (OR 0.47; 95% CI 0.23-0.96; p = 0.04) and required less morphine (adjusted difference, -72.8 mg; 95% CI 4.9-141; p = 0.04).
The inherent selection bias of this retrospective cohort study may not be accounted for by multivariate analysis with propensity-score adjustment.
Laparoscopic subtotal colectomy is safe and may reduce the rate of minor postoperative complications. The increase in operative duration reflects the technical demands associated with this procedure (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A160).
炎症性肠病（IBD）患者行腹腔镜与开腹次全结肠切除术的对比结局数据缺乏，且由于病例数量少、病例组合异质性以及腹腔镜技术的差异，这些数据往往难以解读。
本研究旨在确定腹腔镜次全结肠切除术治疗重症结肠炎的安全性，并确定与开腹手术相比，腹腔镜手术方法是否能改善短期结局。
这是一项回顾性队列研究，使用来自前瞻性维护的临床数据库的数据。
本研究在多伦多西奈山医院这一单一中心进行。
纳入2000年至2011年间因溃疡性结肠炎或克罗恩病接受次全结肠切除术的所有患者。
腹腔镜和开腹次全结肠切除术均采用标准化手术技术。排除由非腹腔镜外科医生实施的病例。
围手术期结局指标包括手术时间、估计失血量、吗啡总需求量和术后住院时间。术后结局指标为轻微和严重并发症的发生率。
290例中有131例（45.2%）行腹腔镜次全结肠切除术。9例患者需要转为开腹手术（6.9%）。腹腔镜次全结肠切除术的采用率从2000/2001年的10.2%增至2010/2011年的71.7%。对手术方式进行倾向得分调整的回归分析显示，腹腔镜手术病例的手术时间长25.5分钟（95%可信区间12.3 - 38.6；p < 0.001）, 但患者发生的轻微并发症较少（比值比0.47；95%可信区间0.23 - 0.96；p = 0.04），且所需吗啡较少（校正差值，-72.8毫克；95%可信区间4.9 - 141；p = 0.04）。
这项回顾性队列研究固有的选择偏倚可能无法通过倾向得分调整的多变量分析来解释。
腹腔镜次全结肠切除术是安全的，且可能降低术后轻微并发症的发生率。手术时间的延长反映了该手术相关的技术要求（见视频，补充数字内容1，http://links.lww.com/DCR/A160）。
