Wang Jian, Yao Danhua, Zhang Shaoyi, Mao Qi, Li Yousheng, Li Jieshou
Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
J Surg Res. 2015 Apr;194(2):415-419. doi: 10.1016/j.jss.2014.11.026. Epub 2014 Nov 21.
The aim of this study was to determine the safety and feasibility of laparoscopic surgery for radiation enteritis-induced intestinal stenosis requiring ileocecal resection.
Clinical records of radiation enteritis patients that underwent laparoscopic ileocecal resection and ileo-ascending colonic side-to-side anastomosis in a single center from January 2012-February 2014 were retrospectively analyzed. Thirty patients were identified and matched by abdominal adhesion grade, age, gender, primary malignancy distribution, previous abdominal surgery history, and body mass index to 30 patients that underwent open surgery for the same procedure from August 2009-December 2011. General information, operative findings, and short-term outcomes were compared between the two groups.
The conversion rate of laparoscopic surgery was 23.3%. The length of skin incision in the laparoscopic group was significantly shorter than that of the open surgery group (6.8 cm versus 15.8 cm, P = 0.001). Laparoscopic surgery significantly decreased recovery time to total enteral nutrition (10.3 d versus 15.6 d, P = 0.037); however, postoperative hospital stay was not significantly different between the two groups (28.2 d versus 32.4 d, P = 0.924). Intraoperative blood loss (125 mL versus 189 mL, P = 0.000) and operation time (138 min versus 171 min, P = 0.003) were significantly improved in the laparoscopic group compared with those in the open surgery group. Laparoscopic surgery did not significantly decrease postoperative morbidity but did decrease the pleural effusion rate.
Laparoscopic surgery is feasible for treatment of radiation enteritis-induced intestinal stenosis with a relatively low conversion rate. Laparoscopic surgery is as safe as open surgery and is superior to open surgery with decreased skin incision length, operation time, intraoperative blood loss, and postoperative recovery time to total enteral nutrition.
本研究旨在确定腹腔镜手术治疗因放射性肠炎导致的需要回盲部切除的肠道狭窄的安全性和可行性。
回顾性分析2012年1月至2014年2月在单一中心接受腹腔镜回盲部切除及回肠-升结肠侧侧吻合术的放射性肠炎患者的临床记录。确定了30例患者，并根据腹部粘连分级、年龄、性别、原发性恶性肿瘤分布、既往腹部手术史和体重指数与2009年8月至2011年12月接受相同手术的30例开腹手术患者进行匹配。比较两组患者的一般信息、手术发现和短期结局。
腹腔镜手术的中转率为23.3%。腹腔镜组的皮肤切口长度明显短于开腹手术组（6.8 cm对15.8 cm，P = 0.001）。腹腔镜手术显著缩短了完全肠内营养的恢复时间（10.3天对15.6天，P = 0.037）；然而，两组患者的术后住院时间无显著差异（28.2天对32.4天，P = 0.924）。与开腹手术组相比，腹腔镜组的术中出血量（125 mL对189 mL，P = 0.000）和手术时间（138分钟对171分钟，P = 0.003）有显著改善。腹腔镜手术并未显著降低术后发病率，但降低了胸腔积液发生率。
腹腔镜手术治疗放射性肠炎所致肠道狭窄是可行的，中转率相对较低。腹腔镜手术与开腹手术一样安全，且在减少皮肤切口长度、手术时间、术中出血量及术后完全肠内营养恢复时间方面优于开腹手术。
