克罗恩病腹腔镜手术治疗的临床研究

Laparoscopic surgery for the treatment of Crohn′s disease

目的：评估克罗恩病腹腔镜（辅助）手术治疗的可行性及近期疗效。方法：对2010年2月至2012年3月在我科接受腹腔镜（辅助）手术21例克罗恩病病人的临床资料进行回顾性分析．统计分析其手术时间、术中失血量、术后进食时间、术后住院天数、中转开腹率及并发症发生率。结果：21例病人中19例成功完成腹腔镜（辅助）手术。手术方式主要为回盲部切除10例，小肠切除6例，降结肠部分切除2例，末端回肠造口1例。平均手术时间为（125±19）min，术中平均失血量（100±71）mL，术后中位进食时间6（4～14）d，术后中位住院时间9（7-40）d．中转开腹率为9．5％，并发症发生率为26．3％。结论：克罗恩病的腹腔镜手术治疗安全、有效，手术时间、中转开腹率及并发症发生率在合理可控范围，且有术后恢复快、疼痛轻和切口美观的优点．具有临床推广价值。

Objective To assess the feasibility and short-term effects of the laparoscopic approach in the treatment of Crohn＇s disease. Methods From Feb 2010 to Mar 2012, twenty-one patients with Crohn＇s disease underwent laparoscopic operations and the clinical data of operative time, blood loss, time to regular diet, length of postoperative hospita-lization, the conversion rate and the complication rate were reviewed retrospectively. Results All the patients underwent laparoscopic surgery, except two patients （9.5%） required conversion to an open procedure. The surgical procedure inclu-ded ileocolectomy （n=10）, small bowel resection （n=6）, partial coleetomy for descending colon stricture （n：2） and dysfunctioning ileostomy （n=l）. The median operative time was （125±19） rain, median blood loss was （100±71） mL, median time to regular diet was 6 days （range, 4-14 d）, and median length of postoperative hospitalization was 9 days （range, 7-40 d）. The conversion rate was 9.5% and the overall morbidity rate was 26.3%. Conclusions Laparoscopic surgery in patients with Crohn＇s disease can be accomplished safely and with reasonable operative time, conversion rate and morbidity rate. The major advantages of the laparoscopic approach are short recovery, improved cosmesis, less postoperative pain and patient＇s satisfaction.