Holder-Murray Jennifer, Marsicovetere Priscilla, Holubar Stefan D
*Department of Surgery, Division of Colon and Rectal Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and †Division of Colon and Rectal Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Inflamm Bowel Dis. 2015 Jun;21(6):1443-58. doi: 10.1097/MIB.0000000000000316.
Surgical management of inflammatory bowel disease is a challenging endeavor given infectious and inflammatory complications, such as fistula, and abscess, complex often postoperative anatomy, including adhesive disease from previous open operations. Patients with Crohn's disease and ulcerative colitis also bring to the table the burden of their chronic illness with anemia, malnutrition, and immunosuppression, all common and contributing independently as risk factors for increased surgical morbidity in this high-risk population. However, to reduce the physical trauma of surgery, technologic advances and worldwide experience with minimally invasive surgery have allowed laparoscopic management of patients to become standard of care, with significant short- and long-term patient benefits compared with the open approach. In this review, we will describe the current state-of the-art for minimally invasive surgery for inflammatory bowel disease and the caveats inherent with this practice in this complex patient population. Also, we will review the applicability of current and future trends in minimally invasive surgical technique, such as laparoscopic "incisionless," single-incision laparoscopic surgery (SILS), robotic-assisted, and other techniques for the patient with inflammatory bowel disease. There can be no doubt that minimally invasive surgery has been proven to decrease the short- and long-term burden of surgery of these chronic illnesses and represents high-value care for both patient and society.
鉴于存在感染性和炎症性并发症，如瘘管和脓肿，以及复杂的术后解剖结构，包括既往开放手术导致的粘连性疾病，炎症性肠病的外科治疗是一项具有挑战性的工作。克罗恩病和溃疡性结肠炎患者还面临着慢性疾病带来的负担，如贫血、营养不良和免疫抑制，这些都是常见的，并且各自独立地作为这一高风险人群手术发病率增加的危险因素。然而，为了减少手术的身体创伤，技术进步和全球范围内的微创手术经验使腹腔镜治疗患者成为标准治疗方法，与开放手术相比，患者在短期和长期都有显著益处。在本综述中，我们将描述炎症性肠病微创手术的当前技术水平以及在这一复杂患者群体中这种治疗方法固有的注意事项。此外，我们将回顾微创手术技术的当前和未来趋势，如腹腔镜“无切口”、单切口腹腔镜手术（SILS）、机器人辅助手术以及其他针对炎症性肠病患者的技术的适用性。毫无疑问，微创手术已被证明可以减轻这些慢性疾病手术的短期和长期负担，对患者和社会而言都是高价值的治疗方法。
