Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC.
World J Emerg Surg. 2022 Oct 13;17(1):53. doi: 10.1186/s13017-022-00458-4.
Laparoscopic colectomy is rarely performed for ischemic colitis. The aim of this propensity score-matched study was to compare preoperative characteristics, intraoperative details and short-term outcomes for emergent laparoscopic colectomy versus the traditional open approach for patients with ischemic colitis.
Retrospective review of 96 patients who underwent emergent colectomy for ischemic colitis between January 2011 and December 2020 (39 via laparoscopy, 57 via laparotomy) was performed. We compared short-term outcomes after using a one-to-one ratio and nearest-neighbor propensity score matching to obtain similar preoperative and intraoperative parameters in each group.
Patients in the open group experienced more surgical site complications (52.6% vs. 23.0%, p = 0.004), more intra-abdominal abscesses (47.3% vs. 17.9%, p = 0.003), longer need for ventilator support (20 days vs. 0 days, p < 0.001), more major complications (77.2% vs. 43.5%, p = 0.001), higher mortality (49.1% vs. 20.5%, p = 0.004), and longer hospital stay (32 days vs. 19 days, p = 0.001). After propensity score matching (31 patients in each group), patients undergoing open (vs. laparoscopy) had more surgical site complications (45.1% vs. 19.4%, p = 0.030) and required longer ventilator support (14 vs. 3 days, p = 0.039). After multivariate analysis, Charlson Comorbidity Index (p = 0.024), APACHE II score (p = 0.001), and Favier's classification (p = 0.023) were independent predictors of mortality.
Laparoscopic emergent colectomy for ischemic colitis is feasible and is associated with fewer surgical site complications and better respiratory function, compared to the open approach.
腹腔镜结肠切除术很少用于缺血性结肠炎。本研究采用倾向评分匹配法，旨在比较腹腔镜与传统开腹手术治疗缺血性结肠炎的患者的术前特征、手术细节和短期结局。
回顾性分析 2011 年 1 月至 2020 年 12 月期间 96 例因缺血性结肠炎而行急诊结肠切除术的患者（腹腔镜 39 例，开腹 57 例）。我们比较了采用 1:1 比例和最近邻倾向评分匹配后，两组患者的短期结局。
开放组患者的手术部位并发症（52.6% vs. 23.0%，p=0.004）、腹腔脓肿（47.3% vs. 17.9%，p=0.003）、机械通气时间（20 天 vs. 0 天，p<0.001）、主要并发症（77.2% vs. 43.5%，p=0.001）、死亡率（49.1% vs. 20.5%，p=0.004）和住院时间（32 天 vs. 19 天，p=0.001）均较高。经倾向评分匹配（每组 31 例）后，开放组（vs. 腹腔镜组）的手术部位并发症（45.1% vs. 19.4%，p=0.030）和机械通气时间（14 天 vs. 3 天，p=0.039）均较长。多因素分析显示，Charlson 合并症指数（p=0.024）、急性生理和慢性健康评分（p=0.001）和 Favier 分类（p=0.023）是死亡率的独立预测因素。
与开腹手术相比，腹腔镜治疗缺血性结肠炎是可行的，可减少手术部位并发症，改善呼吸功能。
