克罗恩病的回结肠切除术：微创方法崭露头角。

Ileocolic Resection for Crohn's Disease: A Minimally Invasive Approach Claims Its Place.

作者信息

Alizadeh Reza Fazl, Chaudhry Haris H, Li Shiri, Jafari Mehraneh D, Mills Steven D, Carmichael Joseph C, Pigazzi Alessio, Monson John R T, Stamos Michael J

机构信息

Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California, USA.

出版信息

Am Surg. 2018 Oct 1;84(10):1639-1644.

PMID:30747686

Abstract

Ileocolic resection is the most common operation performed for Crohn's disease patients with terminal ileum involvement. We sought to evaluate the outcomes in Crohn's disease patients who underwent open ileocolic resection (OIC) and laparoscopic ileocolic resection (LIC) by using the ACS-NSQIP database from 2006 to 2015. Of 5670 patients, 48.3 per cent (2737) patients had OIC and 51.7 per cent (2933) had LIC. The number of LIC increased from 40 per cent in 2006 to 60.7 per cent in 2015. Moreover, the annual number of LIC surgeries has exceeded the number of OIC surgeries since 2013. Patients in the LIC group had shorter hospital length of stay compared with OIC group (6 ± 5 days 8.6 ± 8 days, < 0.01). The LIC procedure also had shorter operation time compared with OIC (148 ± 58 153 ± 76 minutes, = 0.01). Overall morbidity (15.8% 25.3%, AOR: 0.54, confidence interval (CI): 0.46-0.62, < 0.01), serious morbidity (10.9% 18%, AOR: 0.55, CI: 0.46-0.65, < 0.01), and SSI (9.9% 15.5%, AOR: 0.59, CI: 0.49-0.70, < 0.01) rates were lower in the LIC group than the OIC group. We demonstrated that in Crohn's disease patients, LIC has improved outcomes for ileocolic resection compared with OIC and has been chosen as the preferential treatment approach for most patients.

摘要

回结肠切除术是对累及末端回肠的克罗恩病患者最常施行的手术。我们试图利用2006年至2015年的美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，评估接受开放性回结肠切除术（OIC）和腹腔镜回结肠切除术（LIC）的克罗恩病患者的手术结果。在5670例患者中，48.3%（2737例）患者接受了OIC，51.7%（2933例）患者接受了LIC。LIC的比例从2006年的40%增至2015年的60.7%。此外，自2013年以来，LIC手术的年例数已超过OIC手术的年例数。与OIC组相比，LIC组患者的住院时间更短（6±5天对8.6±8天，P<0.01）。LIC手术的操作时间也比OIC短（148±58分钟对153±76分钟，P=0.01）。LIC组的总体并发症发生率（15.8%对25.3%，校正比值比[AOR]：0.54，置信区间[CI]：0.46-0.62，P<0.01）、严重并发症发生率（10.9%对18%，AOR：0.55，CI：0.46-0.65，P<0.01）和手术部位感染（SSI）发生率（9.9%对15.5%，AOR：0.59，CI：0.49-0.70，P<0.01）均低于OIC组。我们证明，对于克罗恩病患者，与OIC相比，LIC改善了回结肠切除术的手术结果，并且已被大多数患者选为优先治疗方法。