Department of Chirurgia Generale e Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Torino, Italy.
Department of Chirurgia Generale e Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Torino, Italy.
Int J Surg. 2018 Jul;55:201-206. doi: 10.1016/j.ijsu.2018.04.006. Epub 2018 Apr 10.
Patients with ulcerative colitis are often young, and proctocolectomy with restorative ileo-pouch anal anastomosis is a crucial act that can improve or worsen the quality of the rest of their lives. The literature is scant on long-term functional outcomes after laparoscopy. The purpose of this study was to investigate results in terms of pouch function after standardized total laparoscopic technique compared with open intervention.
This was a retrospective comparative study. Cases were collected from the prospectively-maintained database of the Unit of General and Oncologic Surgery, XXX, Torino, Italy. Patients treated between May 2005 and May 2015 with three-stage laparoscopic or open proctocolectomy and ileo-pouch anal anastomosis were enrolled. The primary study endpoint was the percentage of well-functioning pouches. Secondary endpoints were postoperative early and late outcomes such as morbidity and pouch survival.
Of the 78 patients identified, 48 underwent the open technique and 30 underwent laparoscopy. Median follow-up was 4 years. The overall complication rates were 19% and 13% (p = 0.5), and there were major complications (Clavien-Dindo III-IV) in 14.6% and 13.3% of patients in the open and laparoscopic groups, respectively (p = 0.8). Late complications occurred in 26 patients. Nine (18.8%) and 5 (16.7%) patients had pouchitis (p = 0.8), and 6 (12.5%) and 2 (6.7%) had cuffitis in the open and laparoscopic groups, respectively (p = 0.70). Pouch failure occurred in 2 patients (4.2%) in the open group and 2 (6.7%) in the laparoscopic group. The pouch was observed to be functioning very well in 18 patients (37.5%) in the open group and in 17 patients (56%) in the laparoscopic group (p = 0.09). The study was limited by its retrospective, nonrandomized design.
Our data demonstrated similar early and late results after total laparoscopic and open proctocolectomy, in particular concerning pouch function.
溃疡性结肠炎患者通常较为年轻，施行直肠结肠切除术并进行直肠储袋肛管吻合术可以改善甚至改变他们的余生质量。但腹腔镜手术的长期功能结果的相关文献较少。本研究旨在探究标准化全腹腔镜技术与开放干预相比的储袋功能结果。
这是一项回顾性比较研究。病例来自意大利都灵 XXX 普外科和肿瘤外科的前瞻性数据库。研究纳入了 2005 年 5 月至 2015 年 5 月期间接受三阶段腹腔镜或开放直肠结肠切除术及直肠储袋肛管吻合术的患者。主要研究终点为功能良好的储袋比例。次要终点为术后早期和晚期结果，如发病率和储袋存活率。
共确定 78 例患者，其中 48 例行开放手术，30 例行腹腔镜手术。中位随访时间为 4 年。总的并发症发生率为 19%和 13%（p=0.5），开放组和腹腔镜组分别有 14.6%和 13.3%的患者发生主要并发症（Clavien-Dindo III-IV 级）（p=0.8）。26 例患者发生晚期并发症。9 例（18.8%）和 5 例（16.7%）患者发生储袋炎（p=0.8），开放组和腹腔镜组分别有 6 例（12.5%）和 2 例（6.7%）发生袖口炎（p=0.70）。开放组有 2 例（4.2%）和腹腔镜组有 2 例（6.7%）患者发生储袋失败。开放组有 18 例（37.5%）和腹腔镜组有 17 例（56%）患者的储袋功能非常好（p=0.09）。该研究受到回顾性、非随机设计的限制。
本研究数据表明，全腹腔镜和开放直肠结肠切除术的早期和晚期结果相似，特别是在储袋功能方面。
