Singh K, Prasad A, Saunders J H, Foley R J
Bedford Hospital NHS Trust, UK.
J Laparoendosc Adv Surg Tech A. 1998 Feb;8(1):39-46. doi: 10.1089/lap.1998.8.39.
We have tried to evaluate the role of laparoscopy and laparoscopic-assisted surgery in the management of Crohn's disease. Over a 4-year period, we had 38 patients, of which 23 patients were suspected to have Crohn's disease and were admitted for diagnostic laparoscopy while 15 patients had already had a biopsy confirmation of Crohn's disease in the past and were admitted for specifically planned procedures. In the first group of 23 patients, 11 were found not to have Crohn's disease. In the remaining 12 patients, three were proven to have Crohn's disease, but no surgical procedure was undertaken. The remaining nine patients underwent laparoscopic-assisted procedures, of which two required conversion to a laparotomy because of intra-abdominal abscesses. All 15 patients in the second group underwent laparoscopic or laparoscopic-assisted procedures. In total, 14 patients were spared a potential diagnostic laparotomy and could go home the next day. The remaining 24 patients underwent procedures requiring longer hospital stays; five had a purely laparoscopic procedure, 17 had a laparoscopic-assisted procedure, and two required a laparotomy. Although there was little difference in the median stay for patients treated laparoscopically or by laparotomy, it is thought that the extent or severity of the disease process influenced the length of the stay rather than the approach used. The complication rate was similar to that found in Crohn's patients undergoing open surgery. It remains to be seen whether those in the laparoscopically treated group have less adhesive complications than those treated by laparotomy. It is our belief that laparoscopy is a valuable aid in the diagnosis of Crohn's disease. It remains to be proven whether or not laparoscopic-assisted surgery will be of significant value in the treatment of this condition.
我们试图评估腹腔镜检查及腹腔镜辅助手术在克罗恩病治疗中的作用。在4年期间，我们共收治了38例患者，其中23例疑似患有克罗恩病，因诊断性腹腔镜检查入院；15例既往已通过活检确诊为克罗恩病，因特定的手术计划入院。在第一组23例患者中，11例被发现没有患克罗恩病。在其余12例患者中，3例被证实患有克罗恩病，但未进行手术。其余9例患者接受了腹腔镜辅助手术，其中2例因腹腔脓肿而中转开腹。第二组的15例患者均接受了腹腔镜或腹腔镜辅助手术。总共有14例患者避免了可能的诊断性开腹手术，术后第二天即可出院。其余24例患者接受了需要更长住院时间的手术；5例接受了单纯腹腔镜手术，17例接受了腹腔镜辅助手术，2例需要开腹手术。虽然接受腹腔镜手术或开腹手术的患者中位住院时间差异不大，但认为疾病进程的程度或严重程度影响住院时间，而非手术方式。并发症发生率与接受开放手术的克罗恩病患者相似。腹腔镜治疗组患者的粘连并发症是否少于开腹手术组患者，仍有待观察。我们认为腹腔镜检查对克罗恩病的诊断有重要帮助。腹腔镜辅助手术在这种疾病的治疗中是否具有重要价值，仍有待证实。
