腹腔镜全结肠直肠切除治疗家族性息肉病八例

Total colectomy and proctocolectomy under laparoscopic for familial adenomatous polyposis

目的探讨腹腔镜全结肠、直肠切除治疗家族性息肉病的有效性和优越性。方法我们应用腹腔镜对8例家族性息肉患者行全结肠直肠切除,回肠储袋肛管吻合。观察手术安全性、术后恢复情况以及随访结果并与2001年以前开腹全结肠切除的6例患者作为对照比较。结果 8例患者均顺利行腹腔镜全结肠切除术,无中转开腹手术,平均手术时间为178 min(165～210 min),与开腹组比,差异无统计学意义(P>0.05);平均出血量110 ml(70～200 ml),肛门排气时间1.2 d(1～3 d),住院时间12.5 d(10～18 d),与开腹组相比差异有统计学意义(P>0.05)。术后无严重并发症发生。随访32～58个月,平均46.8个月,腹腔镜组无局部复发,开腹组1例患者术后25个月直肠复发并癌变。术后1个月内控便困难,每天排便9～10次,有便意;术后3个月每天排便4～8次,能控制成形大便,但水样便及气体控制困难;术后6个月每天排便3～5次,能控制成形大便,基本能控制水样便及气体;术后9个月后每天排便2～3次,能随意控制成形大便、水样便及气体。结论腹腔镜行全结肠、直肠切除治疗家族性息肉病具有安全、有效、微创、术后疼痛小、住院时间短等优点。熟练的腹腔镜技术是手术成功的保证。

Objective To evaluate the efficacy and characteristics of treating familial adenomatous polyposis （FAP） by total colectomy and proctocolectomy under laparoscopy. Methods The perioperative data, including surgical outcomes, safety, and recovery of 8 FAP patients, 5 males and 3 females, aged 59 （28 - 65 ）, who underwent laparoscopic total colectomy and proctocolectomy were analyzed retrospectively and follow-up of 46.8 months （32 - 58 months） between April 2001 and January 2003 were analyzed and compared with the data of 6 patients undergoing conventional open surgery before 2001. Results Laparoseopie total colectomy and proctocolectomy were performed successfully without severe complications on the 8 patients. The mean operation time of the laparoscopy group was 178 min, not significantly different from that of the conventional group （ 170 min, P 〉 0. 05 ）. The mean intra-operative blood loss, anal exsufflation time, and hospital stay, and incision length of the laparoscopy group was 110 ml, 1.2 d, 12.5 d, and 0 cm, all significantly shorter than those of the conventional group （211 ml, 3.1 d, 17.4 d , and 22.3 em, P〈0. 05 or P 〈0.01 ）. Follow-up showed no local recurrence. The function of stool controlling was good 9 months after the operation. Conclusion With less trauma and pain, rapid recovery, and shorter hospital stay, laparoscopic total colectomy and proctocolectomy is feasible and safe for FAP. It must be performed by skilled and experienced surgeons.