腹腔镜手术治疗溃疡性结直肠炎

Laparoscopic surgery for ulcerative colitis

目的探讨腹腔镜手术治疗溃疡性结直肠炎的可行性和安全性。方法对腹腔镜手术治疗溃疡性结直肠炎5例患者的临床资料进行回顾性分析。结果5例均在腹腔镜下完成手术,其中4例行全结-直肠切除,回肠储袋-肛管吻合术(total proctocolectomy and ileal pouch-anal anastomosis,IPAA),1例行结肠次全-全直肠切除,盲肠-肛管吻合术。中位手术时间7.5(6.5～9)h,中位出血量250(150～400)mL,中位术后进半流食时间62(60～86)h,中位术后住院时间12(10～14)d。术后发生盆腔感染1例,粘连性肠梗阻1例。随访中位时间22(10～34)个月,大便平均每天6.5(4～10)次。日常生活自理,工作正常,无复发。结论腹腔镜下溃疡性结直肠炎手术,创伤小,恢复快,安全可靠,但尚需进一步积累临床资料。

Objective To investigate the feasibility and safety of laparoscopic surgical treatment of ulcerative colitis （ UC ）. Methods The clinical data of 5 cases who underwent laparoscopic surgery for the treatment of ulcerative colitis were reviewed. Results All 5 cases successfully underwent laparoscopic surgery. Among them, 4 had total proctocolectomy and ileal pouch-anastomosis （IPAA） , and 1 had subtotal colectomy plus total proctectomy, and cecum-anal anastomosis. The median operating time was 7. 5 （ 6. 5 - 9 ） h, the median blood loss was 250（ 150 -400 ）mL, the median time to begin semi-fluid intake after operation was 62 （ 60 - 86 ） h, the median time of hospital stay was 12 （ 10 - 14 ） d, Postoperative pelvic infection occurred in 1 case, adhesive intestinal obstruction occurred in another case. The median follow-up time was 22（ 10- 34）months, and the average number of daily bowel movement was 6. 5 （4 - 10 ）d; they were relapse-free, and had normal daily living and work at follow-up. Conclusions Laparoscopic surgical treatment of ulcerative colitis is associated with minor trauma and rapid recovery, and is safe and reliable, but further accumulation of cases is required.