Schwandner O, Schiedeck T H, Bruch H P
Int J Colorectal Dis. 1998;13(5-6):251-5. doi: 10.1007/s003840050171.
This study assessed the results of laparoscopic stoma creation for fecal diversion. All patients who underwent elective laparoscopic stoma creation as the sole procedure were evaluated prospectively. Univariate analysis was performed to determine whether previous abdominal surgery, age, gender, body mass index, indication, or surgeons' experience has an effect on the outcome. Between November 1992 and May 1998, 42 patients (17 males, 25 females) with a mean age of 62.1 years (range 17-91) underwent laparoscopic stoma formation. Fecal diversion included loop ileostomy (n = 7), loop sigmoid colostomy (n = 32), and end-sigmoid colostomy (n = 3). Most common indications were unresectable rectal cancer, rectal obstruction caused by advanced pelvic tumors and benign disorders such as perianal Crohn's disease, and fecal incontinence. Of the 42 procedures 41 were completed laparoscopically (97.6%). Complications occurred in four patients (9.5%) requiring reoperation in two (4.8%). Mean length of surgery was 74.4 min (range 30-200). First bowel movements resumed on the 3rd day (range 2nd-7th) after surgery and patients were discharged from hospital after 13 days (range 6-47). Short-term results (> 30 days-1 year) indicated that no further stoma-related complications occurred. Analyzing factors potentially predictive of outcome, no statistically significant differences were documented in relation to previous abdominal surgery, age, gender, body mass index, indication, or surgeons' experience (P > 0.05). Laparoscopic stoma creation is appropriate to achieve fecal diversion because it is technically feasible and can be performed with low morbidity. In addition to the benefits of the minimally invasive technique for the patients, laparoscopic stoma formation can be ideal for the surgeon as basic and initial step to perform laparoscopic colorectal procedures.
本研究评估了腹腔镜造口术用于粪便转流的效果。对所有接受择期腹腔镜造口术作为唯一手术的患者进行了前瞻性评估。进行单因素分析以确定既往腹部手术、年龄、性别、体重指数、适应证或外科医生经验是否对结果有影响。在1992年11月至1998年5月期间，42例患者（男17例，女25例）平均年龄62.1岁（范围17 - 91岁）接受了腹腔镜造口术。粪便转流包括回肠袢式造口术（n = 7）、乙状结肠袢式造口术（n = 32）和乙状结肠端式造口术（n = 3）。最常见的适应证是不可切除的直肠癌、晚期盆腔肿瘤和良性疾病（如肛周克罗恩病）引起的直肠梗阻以及大便失禁。42例手术中有41例通过腹腔镜完成（97.6%）。4例患者（9.5%）出现并发症，其中2例（4.8%）需要再次手术。平均手术时长为74.4分钟（范围30 - 200分钟）。术后第3天（范围第2 - 7天）恢复首次排便，患者术后13天（范围6 - 47天）出院。短期结果（> 30天 - 1年）表明未发生进一步的造口相关并发症。分析可能预测结果的因素，在既往腹部手术、年龄、性别、体重指数、适应证或外科医生经验方面未发现统计学上的显著差异（P > 0.05）。腹腔镜造口术适用于实现粪便转流，因为它在技术上可行且发病率低。除了微创技术对患者的益处外，腹腔镜造口术对外科医生而言可能是开展腹腔镜结直肠手术的理想基础和初始步骤。
