Reissman P, Salky B A, Pfeifer J, Edye M, Jagelman D G, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Am J Surg. 1996 Jan;171(1):47-50; discussion 50-1. doi: 10.1016/s0002-9610(99)80072-5.
The role of laparoscopic surgery in the treatment of various upper and lower gastrointestinal disorders is still under investigation. However, a variety of laparoscopic procedures may be applied in the treatment of inflammatory bowel disease (IBD).
We present our initial results of laparoscopic and laparoscopic-assisted management of IBD in 72 consecutive patients (37 women and 35 men; mean age 36 years, range 20 to 79). The indications for surgery included: terminal ileitis in 29 patients, mucosal ulcerative colitis in 23 patients, Crohn's colitis in 11 patients, severe perianal Crohn's disease in 4 patients, duodenal Crohn's disease in 3 patients, Crohn's rectovaginal fistula in 1 patient, and rectourethral fistula in 1 patient. The procedures performed included: total abdominal colectomy (TAC) in 30 patients (22 with total proctocolectomy with ileoanal reservoir, 6 with TAC with ileorectal anastomosis, and 2 with TAC with end ileostomy), ileocolic resection in 30 patients, diverting loop ileostomy in 6 patients, closure of an end ileostomy as an ileorectal anastomosis in 3 patients who already underwent a TAC with end ileostomy, and duodenal bypass gastrojejunostomy in 3 patients.
There were 16 complications in 13 (18%) patients: 3 enterotomies, 4 episodes of bleeding, 3 pelvic abscesses, 2 intestinal obstructions, 2 prolonged ileus, 1 anastomotic leak, and 1 efferent loop obstruction after gastrojejunostomy. However, only 3 patients required laparotomy for morbidity, and there was no mortality. In 7 (10%) patients, the laparoscopic procedure was converted to a laparotomy due to a large inflammatory mass with fistula in 4 patients, bleeding in 2 patients, and an enterotomy in 1 patient. The mean operating time was 2.9 hours (range 0.7 to 6) and the mean length of hospital stay was 6.5 days (range 3 to 19). When compared with ileocolic resection, total colectomy was associated with higher morbidity (30% versus 10%, P < 0.05) and longer hospitalization (8.7 days [range 4 to 19] versus 5.2 days [range 3 to 7], respectively; P < 0.05).
According to this initial experience, laparoscopic surgery is a versatile and effective modality in the surgical management of inflammatory bowel disease in selected patients. However, laparoscopic total colectomy is associated with higher morbidity when compared with ileocolic resection.
腹腔镜手术在治疗各种上、下消化道疾病中的作用仍在研究中。然而，多种腹腔镜手术可应用于炎症性肠病（IBD）的治疗。
我们展示了对72例连续IBD患者（37例女性和35例男性；平均年龄36岁，范围20至79岁）进行腹腔镜及腹腔镜辅助治疗的初步结果。手术指征包括：29例患者为末端回肠炎，23例患者为黏膜溃疡性结肠炎，11例患者为克罗恩结肠炎，4例患者为重度肛周克罗恩病，3例患者为十二指肠克罗恩病，1例患者为克罗恩直肠阴道瘘，1例患者为直肠尿道瘘。实施的手术包括：30例患者行全腹结肠切除术（TAC）（22例患者行全直肠结肠切除术并回肠肛管储袋术，6例患者行TAC并回肠直肠吻合术，2例患者行TAC并末端回肠造口术），30例患者行回结肠切除术，6例患者行转流性回肠造口术，3例已行TAC并末端回肠造口术的患者行末端回肠造口关闭术作为回肠直肠吻合术，3例患者行十二指肠旁路胃空肠吻合术。
13例（18%）患者出现16例并发症：3例肠切开术，4例出血事件，3例盆腔脓肿，2例肠梗阻，2例肠麻痹延长，1例吻合口漏，1例胃空肠吻合术后输出袢梗阻。然而，仅3例患者因发病需要剖腹手术，且无死亡病例。7例（10%）患者因4例患者存在巨大炎性包块伴瘘、2例患者出血以及1例患者肠切开术，腹腔镜手术转为剖腹手术。平均手术时间为2.9小时（范围0.7至6小时），平均住院时间为6.5天（范围3至19天）。与回结肠切除术相比，全结肠切除术的发病率更高（30%对10%，P<0.05），住院时间更长（分别为8.7天[范围4至19天]对5.2天[范围3至7天]；P<0.05）。
根据这一初步经验，腹腔镜手术在特定患者的炎症性肠病手术治疗中是一种通用且有效的方式。然而，与回结肠切除术相比，腹腔镜全结肠切除术的发病率更高。
