Wexner S D, Reissman P, Pfeifer J, Bernstein M, Geron N
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Surg Endosc. 1996 Feb;10(2):133-6. doi: 10.1007/BF00188358.
This study was performed to prospectively assess the results of our first 140 consecutive patients who underwent laparoscopic or laparoscopic-assisted colorectal operations.
The parameters studied included the type and length of procedure, intra- and postoperative complications, conversion to open surgery, and length of ileus and hospitalization.
140 laparoscopic and laparoscopic-assisted procedures were performed between May 1991 and January 1995. The mean patient age was 48 (range 12-88) years; there were 78 males and 62 females. Indications for surgery included inflammatory bowel disease in 47, colorectal carcinoma in 19, diverticular disease in 17, polyps in 16, familial polyposis in 7, colonic inertia in 7, fecal incontinence in 11, sigmoidocele in 3, irradiation proctitis in 3, rectal prolapse in 2, intestinal lymphoma in 2, and miscellaneous conditions in 6. The procedures included 38 total abdominal colectomies (TAC) (ileoanal reservoir 28, ileorectal anastomosis 8 and end ileostomy 2); 70 segmental resections of the colon, small bowel, and rectum; 18 diverting stoma creations; 10 reversal of Hartmann's procedures; and 4 other procedures. In 15 cases, the laparoscopic procedure was converted to a laparotomy (11%); 31 patients (22%) sustained 37 complications, which included: enterotomies(7), hemorrhage(10), intraabdominal abscess(4), prolonged ileus(6), wound infection(4), intestinal obstruction(2), anastomotic leak(1), aspiration(1), cardiac arrhythmia(1), and upper intestinal bleeding(1); there was no mortality. The overall complication rate in TAC cases was significantly higher (42%) when compared to that of all other procedures (segmental resection 17%, others 9%), P < 0.05. The mean length of operating time was 4 (range 2.5-6.5) h for TAC, 2.6 (range 1.5-5.5) h for segmental colonic resections, and 1.7 (range 0.7-4) for all other procedures. The length of ileus was 3.5 (range 2-7) days after TAC, 3 (range 2-7) after the segmental resections and 2 (range 1-4) after the other procedures. The mean length of hospital stay was 6.8 (2-40) days (8.4, 6.5, and 6.3 days for the TAC, segmental resections, and other procedures, respectively).
The feasibility of laparoscopic colorectal surgery has been well established. TAC is associated with a higher complication rate compared to other laparoscopic colorectal procedures.
本研究旨在前瞻性评估连续140例接受腹腔镜或腹腔镜辅助结直肠手术患者的手术结果。
研究参数包括手术类型和时长、术中和术后并发症、中转开腹手术情况、肠梗阻时长及住院时长。
1991年5月至1995年1月间共进行了140例腹腔镜及腹腔镜辅助手术。患者平均年龄48岁（范围12 - 88岁）；男性78例，女性62例。手术适应证包括：炎性肠病47例、结直肠癌19例、憩室病17例、息肉16例、家族性息肉病7例、结肠无力7例、大便失禁11例、乙状结肠膨出3例、放射性直肠炎3例、直肠脱垂2例、肠道淋巴瘤2例、其他情况6例。手术包括38例全腹结肠切除术（TAC）（回肠肛管贮袋术28例、回肠直肠吻合术8例、末端回肠造口术2例）；70例结肠、小肠及直肠节段性切除术；18例造口转流术；10例Hartmann手术回纳术；以及4例其他手术。15例（11%）腹腔镜手术中转开腹；31例患者（22%）出现37种并发症，包括：肠切开7例、出血10例、腹腔内脓肿4例、肠梗阻延长6例、伤口感染4例、肠梗阻2例、吻合口漏1例、误吸1例、心律失常1例、上消化道出血1例；无死亡病例。与所有其他手术（节段性切除术17%、其他手术9%）相比，TAC病例的总体并发症发生率显著更高（42%），P < 0.05。TAC的平均手术时长为4小时（范围2.5 - 6.5小时），结肠节段性切除术为2.6小时（范围1.5 - 5.5小时），所有其他手术为1.7小时（范围0.7 - 4小时）。TAC术后肠梗阻时长为3.5天（范围2 - 7天），节段性切除术后为3天（范围2 - 7天），其他手术后为2天（范围1 - 4天）。平均住院时长为6.8天（2 - 40天）（TAC、节段性切除术及其他手术分别为8.4天、6.5天和6.3天）。
腹腔镜结直肠手术的可行性已得到充分证实。与其他腹腔镜结直肠手术相比，TAC的并发症发生率更高。
