Liu C D, Rolandelli R, Ashley S W, Evans B, Shin M, McFadden D W
Department of Surgery, UCLA Medical Center 90095, USA.
Am Surg. 1995 Dec;61(12):1054-6.
In the setting of inflammatory bowel disease (IBD), laparoscopic approaches have been avoided because of the often fragile intestinal tissue, thickened mesentery, malnutrition, immunosuppression, and the presence of dense adhesions. In this article, we report 10 successfully managed laparoscopic cases in IBD patients (five with ulcerative colitis, five with Crohn's Disease). Patients with ulcerative colitis underwent total abdominal colectomies, mucosal proctectomies, J-pouch construction, and diverting ileostomies. Procedures in patients with Crohn's disease included ileocecectomy (3), sigmoid colectomy with takedown of a transverse colonic fistula (1), and stricturoplasty (1). One of the 10 cases was converted to an open technique for technical reasons. Six of the 10 patients were on high dose corticosteroids for disease control. Hospital stay ranged from 6-13 days, with a median of 7 days. The morbidity rate was 20 per cent, and included one case of mild postoperative pancreatitis in a Crohn's disease patient and one delayed peri-ileostomy fistula in an ulcerative colitis patient. There was no mortality. Based on these results, we conclude that laparoscopic intestinal surgery is both feasible and safe in selected patients with inflammatory bowel disease. Use of laparoscopic techniques in these patients may reduce hospital stay, lessen adhesion formation, and improve cosmetic results in this generally young group of patients.
在炎症性肠病（IBD）的情况下，由于肠道组织通常脆弱、肠系膜增厚、营养不良、免疫抑制以及存在致密粘连，腹腔镜手术方法一直未被采用。在本文中，我们报告了10例成功接受腹腔镜手术的IBD患者（5例溃疡性结肠炎，5例克罗恩病）。溃疡性结肠炎患者接受了全腹结肠切除术、黏膜直肠切除术、J袋构建术和转流性回肠造口术。克罗恩病患者的手术包括回盲部切除术（3例）、乙状结肠切除术并切除横结肠瘘（1例）和狭窄成形术（1例）。10例中有1例因技术原因转为开放手术。10例患者中有6例因疾病控制而使用高剂量皮质类固醇。住院时间为6至13天，中位数为7天。发病率为20%，包括1例克罗恩病患者发生的轻度术后胰腺炎和1例溃疡性结肠炎患者发生的延迟性回肠造口周围瘘。无死亡病例。基于这些结果，我们得出结论，腹腔镜肠道手术在选定的炎症性肠病患者中既可行又安全。在这些患者中使用腹腔镜技术可能会缩短住院时间、减少粘连形成，并改善这群通常较为年轻患者的美容效果。
