Wexner S D, Cohen S M, Ulrich A, Reissman P
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Dis Colon Rectum. 1995 Jul;38(7):723-7. doi: 10.1007/BF02048029.
A survey was undertaken to assess the impact of laparoscopy on the practice of colorectal surgery.
A total of 1,520 questionnaires were mailed to all members of the American Society of Colon and Rectal Surgeons; 635 (42 percent) surgeons responded, 50 percent, and indicated that one questionnaire represented their entire group practice.
Two hundred seventy-eight (47 percent) respondents currently perform laparoscopic colorectal surgery; 62 percent (171) use the laparoscope for < or = 20 percent of their bowel resections. Conversely, only 6 percent (16) use the laparoscope in over 50 percent of resections. The percentage of surgeons who perform various procedures were right colectomy, 78 percent; left colectomy, 57 percent; stoma creations, 52 percent; anterior resection, 44 percent; Hartmann's closure, 42 percent; abdominoperineal resection, 27 percent; rectopexy, 18 percent; and total colectomy, 14 percent. If the preoperative diagnosis is known to be carcinoma, 196 (71 percent) surgeons attempted laparoscopic colorectal surgery, but 55 percent of surgeons (108) operated only for early lesions and 35 percent (68) only for palliation. To enable the procedure to be laparoscopically performed, 87 percent (243) of surgeons stated that they have changed their practice to include routine use of ureteral stents (23 percent), preoperative colonoscopic marking of small lesions (40 percent), or intraoperative colonoscopy. Despite increased use of endoscopy, there were 18 patients in whom the wrong segment of colon was removed. Moreover, nine patients had early local recurrence after resection of colon cancer, nine had early local recurrence after rectal cancer resection, and five had early port-site recurrence. Although 255 (40 percent) surgeons surveyed would themselves undergo laparoscopic colorectal surgery for a rectal villous adenoma, only 38 (6 percent) would have a laparoscopic anterior resection for cancer.
Several important problems exist including early port-site recurrence and a dual surgical standard. Although many surgeons are eager to practice laparoscopic colorectal surgery on their patients with carcinoma, they are reluctant to have the new technique applied to themselves.
开展一项调查以评估腹腔镜检查对结直肠外科手术实践的影响。
总共向美国结直肠外科医师协会的所有成员邮寄了1520份问卷；635名（42%）外科医生进行了回复，其中50%表示一份问卷代表其整个团队的业务情况。
278名（47%）受访者目前开展腹腔镜结直肠手术；62%（171名）在≤20%的肠切除术中使用腹腔镜。相反，只有6%（16名）在超过50%的切除术使用腹腔镜。进行各种手术的外科医生比例分别为：右半结肠切除术78%；左半结肠切除术57%；造口术52%；前切除术44%；哈特曼氏闭合术42%；腹会阴联合切除术27%；直肠固定术18%；全结肠切除术14%。如果术前诊断已知为癌，196名（71%）外科医生尝试进行腹腔镜结直肠手术，但55%的外科医生（108名）仅对早期病变进行手术，35%（68名）仅用于姑息治疗。为了能够进行腹腔镜手术，87%（243名）的外科医生表示他们已改变手术方式，包括常规使用输尿管支架（23%）、术前对小病变进行结肠镜标记（40%）或术中结肠镜检查。尽管内镜检查的使用增加，但仍有18例患者的结肠切除部位错误。此外，9例患者在结肠癌切除术后出现早期局部复发，9例在直肠癌切除术后出现早期局部复发，5例出现早期穿刺孔部位复发。尽管接受调查的255名（40%）外科医生自己会因直肠绒毛状腺瘤接受腹腔镜结直肠手术，但只有38名（6%）会因癌症接受腹腔镜前切除术。
存在几个重要问题，包括早期穿刺孔部位复发和双重手术标准。尽管许多外科医生渴望对患有癌症的患者实施腹腔镜结直肠手术，但他们不愿将这项新技术应用于自己。
