Stage J G, Schulze S, Møller P, Overgaard H, Andersen M, Rebsdorf-Pedersen V B, Nielsen H J
Department of Surgery K, Frederiksberg Hospital, Copenhagen, Denmark.
Br J Surg. 1997 Mar;84(3):391-6.
Laparoscopic techniques have been evaluated for many operations, but retrospective and prospective studies have failed to show these techniques to be superior to open operations in all patients with colorectal disease. This study compares laparoscopic and open colonic resection in a randomized fashion with special reference to outcome, complications and immunomodulation.
The clinical course, assessment of convalescence parameters, immunofunction and pathological evaluation of the operative specimen were compared in 34 patients with colonic adenocarcinoma. The patients were randomized to either laparoscopic surgery (group 1, n = 18) or open surgery (group 2, n = 16). As five patients were excluded the number of patients was 15 in group 1 and 14 in group 2.
Patients in group 1 were discharged earlier (P < 0.05) and suffered less pain (P < 0.01 at rest, P < 0.05 during coughing and mobilization). Surgery was equally radical in the two groups. Intraoperative bleeding, postoperative reduction in pulmonary function, and level of fatigue were identical in the two groups. The immunodepression was more pronounced in patients in group 1 (P < 0.01).
Laparoscopic colonic resection is an acceptable and safe alternative to open procedures; the differences between the two techniques are not marked.
腹腔镜技术已在多种手术中得到评估，但回顾性和前瞻性研究均未能表明这些技术在所有结直肠疾病患者中均优于开放手术。本研究以随机方式比较腹腔镜和开放结肠切除术，特别关注结局、并发症和免疫调节。
比较34例结肠腺癌患者的临床病程、康复参数评估、免疫功能及手术标本的病理评估。患者被随机分为腹腔镜手术组（第1组，n = 18）或开放手术组（第2组，n = 16）。由于5例患者被排除，第1组患者数量为15例，第2组为14例。
第1组患者出院更早（P < 0.05），疼痛更轻（静息时P < 0.01，咳嗽和活动时P < 0.05）。两组手术的根治程度相同。两组术中出血、术后肺功能降低及疲劳程度相同。第1组患者的免疫抑制更明显（P < 0.01）。
腹腔镜结肠切除术是开放手术可接受且安全的替代方法；两种技术之间的差异不明显。
