Kleine U, Kraas E
I. Chirurgische Abteilung, Krankenhaus Moabit Berlin.
Zentralbl Chir. 1995;120(5):400-4.
Laparoscopic colon resection is feasible but not standardized regarding indication and surgical procedure. Indications are mainly benign diseases (diverticulitis, Crohn's disease, ulcerative colitis and sessile dysplastic polyps or adenomas). Rare indications are benign tumors, angiodysplasia of the colon and dolichocolon. Laparoscopic rectopexy and sutural closure of iatrogenic colon perforation have minimal invasive indication, too. Indication for laparoscopic colon resection for malign tumors in T1-stage is still unclear. Use of minimal invasive procedures for palliative reasons (construction of colostomy or bypass anastomoses in malign tumors) is appropriate. In 32 laparoscopic bowel operations we found no lethality. In 5 cases early conversions to laparotomy were necessary. Postoperatively following complications occurred: 1 intraabdominal bleeding, 1 stenosis of anastomosis and 1 wound infection.
腹腔镜结肠切除术是可行的,但在适应证和手术操作方面尚未标准化。适应证主要为良性疾病(憩室炎、克罗恩病、溃疡性结肠炎以及无蒂发育异常息肉或腺瘤)。罕见适应证包括良性肿瘤、结肠血管发育异常和冗长结肠。腹腔镜直肠固定术以及医源性结肠穿孔的缝合关闭也有微创适应证。T1期恶性肿瘤行腹腔镜结肠切除术的适应证仍不明确。出于姑息目的(恶性肿瘤中行结肠造口术或旁路吻合术)使用微创手术是合适的。在32例腹腔镜肠道手术中,我们未发现死亡病例。有5例需要早期转为开腹手术。术后发生了以下并发症:1例腹腔内出血、1例吻合口狭窄和1例伤口感染。