Bauer J J, Harris M T, Grumbach N M, Gorfine S R
Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA.
Dis Colon Rectum. 1995 Jul;38(7):712-5. doi: 10.1007/BF02048027.
The inflammatory process associated with Crohn's disease often makes dissection difficult, even in "open" surgery. This study was undertaken to determine if dissection and resection could be performed laparoscopically and whether it would benefit this group of patients.
Between November 1992 and November 1994, laparoscopic-assisted intestinal resection was attempted in 18 patients with Crohn's disease and was successfully completed in 14. One patient had ileal disease, requiring ileal resection with ileoileal anastomosis. The remainder had disease requiring ileocolic resections. Muscle-splitting incisions averaging 5 cm in length were made to facilitate removal of specimens.
Commencement of oral alimentation was possible at an average of 3.6 (range, 1-7) days postoperatively. Discharge occurred at an average of 6.6 (range, 4-9) postoperative days. In comparison, 14 patients operated on by the authors for the same disease in the open manner during the past six months stayed an average of 8.5 (range, 5-14) postoperative days. Postoperative complications were minimal.
On the basis of this initial study, it appears that laparoscopic-assisted intestinal resection can be readily performed in patients with Crohn's disease. In our early experience, we have found that laparoscopic mobilization and resection may be difficult or impossible in patients with large fixed masses, multiple complex fistulas, or recurrent Crohn's disease. Extraction incisions are frequently so large in these patients that they do not derive the same benefits from laparoscopic surgery that are enjoyed by patients without these findings. Most patients having laparoscopic resections eat earlier, may require fewer narcotics, and are able to be discharged from the hospital an average of two days earlier than patients operated on in an open manner. In addition, it appears that laparoscopic-assisted intestinal resection results in a shorter, easier convalescence and an earlier return to full activity.
与克罗恩病相关的炎症过程常常使手术解剖变得困难，即使在“开放”手术中也是如此。本研究旨在确定是否可以通过腹腔镜进行解剖和切除，以及这是否会使这类患者受益。
在1992年11月至1994年11月期间，对18例克罗恩病患者尝试进行腹腔镜辅助肠切除术，其中14例成功完成。1例患者患有回肠疾病，需要进行回肠切除并回肠-回肠吻合术。其余患者患有需要进行回结肠切除的疾病。做了平均长度为5厘米的肌层劈开切口以利于标本取出。
术后平均3.6天（范围1 - 7天）即可开始经口进食。平均术后6.6天（范围4 - 9天）出院。相比之下，在过去6个月中，作者以开放方式为相同疾病进行手术的14例患者平均术后住院8.5天（范围5 - 14天）。术后并发症极少。
基于这项初步研究，似乎腹腔镜辅助肠切除术可以在克罗恩病患者中顺利进行。根据我们的早期经验，我们发现对于有大的固定肿块、多个复杂瘘管或复发性克罗恩病的患者，腹腔镜游离和切除可能困难或无法进行。这些患者的切口常常很大，以至于他们无法像没有这些情况的患者那样从腹腔镜手术中获得同样的益处。大多数接受腹腔镜切除术的患者进食更早，可能需要的麻醉剂更少，并且比接受开放手术的患者平均早两天出院。此外，腹腔镜辅助肠切除术似乎能使康复过程更短、更轻松，并能更早恢复完全活动。
