韩国溃疡性结肠炎择期两阶段结直肠全切除回肠储袋肛管吻合术的短期结局：腹腔镜手术有优势吗？

Short-term Outcomes of Elective 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea: Does Laparoscopy Have Benefits?

作者信息

Bong Jun Woo, Yoon Yong Sik, Lee Jong Lyul, Kim Chan Wook, Park In Ja, Lim Seok-Byung, Yu Chang Sik, Kim Jin Cheon

机构信息

Division of Colorectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

出版信息

Ann Coloproctol. 2020 Feb;36(1):41-47. doi: 10.3393/ac.2019.03.29. Epub 2020 Feb 29.

DOI:10.3393/ac.2019.03.29

PMID:32146788

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7069676/

Abstract

PURPOSE

This study aimed to compare the short-term outcomes of the open and laparoscopic approaches to 2-stage restorative proctocolectomy (RPC) for Korean patients with ulcerative colitis (UC).

METHODS

We retrospectively analyzed the medical records of 73 patients with UC who underwent elective RPC between 2009 and 2016. Patient characteristics, operative details, and postoperative complications within 30 days were compared between the open and laparoscopic groups.

RESULTS

There were 26 cases (36%) in the laparoscopic group, which had a lower mean body mass index (P = 0.025), faster mean time to recovery of bowel function (P = 0.004), less intraoperative blood loss (P = 0.004), and less pain on the first and seventh postoperative days (P = 0.029 and P = 0.027, respectively) compared to open group. There were no deaths, and the overall complication rate was 43.8%. There was no between-group difference in the overall complication rate; however, postoperative ileus was more frequent in the open group (27.7% vs. 7.7%, P = 0.043). Current smoking (odds ratio [OR], 44.4; P = 0.003) and open surgery (OR, 5.4; P = 0.014) were the independent risk factors for postoperative complications after RPC.

CONCLUSION

Laparoscopic RPC was associated with acceptable morbidity and faster recovery than the open approach. The laparoscopic approach is a feasible and safe option for surgical treatment for UC in selective cases.

摘要

目的

本研究旨在比较开放手术与腹腔镜手术治疗韩国溃疡性结肠炎（UC）患者二期直肠结肠全切除术（RPC）的短期疗效。

方法

我们回顾性分析了2009年至2016年间接受择期RPC的73例UC患者的病历。比较开放手术组和腹腔镜手术组的患者特征、手术细节及术后30天内的并发症。

结果

腹腔镜手术组有26例（36%），与开放手术组相比，其平均体重指数较低（P = 0.025），肠道功能恢复的平均时间更快（P = 0.004），术中出血量更少（P = 0.004），术后第1天和第7天的疼痛更轻（分别为P = 0.029和P = 0.027）。无死亡病例，总体并发症发生率为43.8%。两组总体并发症发生率无差异；然而，开放手术组术后肠梗阻更常见（27.7%对7.7%，P = 0.043）。当前吸烟（比值比[OR]，44.4；P = 0.003）和开放手术（OR，5.4；P = 0.014）是RPC术后并发症的独立危险因素。