手辅助腹腔镜与开腹全结直肠切除回肠储袋肛管吻合术治疗溃疡性结肠炎的对比研究

Hand-assisted laparoscopic versus laparotomy in total proctocolectomy with ileal pouch-analanastomosis： a clinical controlled study

目的比较手辅助腹腔镜技术（HALS）与开腹全结直肠切除回肠储袋肛管吻合术治疗溃疡性结肠炎的应用效果。方法回顾性分析上海交通大学医学院附属新华医院肛肠外科同一组医师自2009年1月至2011年6月期间对溃疡性结肠炎分别采用HALS技术（HALS组．36例）和传统开腹手术（开腹组，42例）完成的全结直肠切除回肠储袋肛管吻合术患者的临床资料．对比其手术安全性、术后恢复情况和并发症。结果HALS组与开腹组的手术时间分别为（300．3±56．4）min和（227．2±34．0）min（P=0．001）；术中出血量分别为（150．2±42．2）ml和（213．5±61．0）ml（P=0．043）：术后排气时间分别为（2．4±0．9）d和（3．1±1．2）d（P=0．026）；进食流质时间分别为（3．7±1．0）d及（4．6±1．7）d（P=0．004）；术后住院时间分别为（9．3±2．6）d及（11．6±3．4）d（P=0．039）：除手术时间稍长外，HALS组均优于开腹手术组。HLAS组术后吻合口瘘、吻合口出血、伤口感染、盆腔脓肿和肠梗阻等手术并发症与开腹组差异无统计学意义（均P〉0．05）。结论手辅助腹腔镜技术在全结直肠切除回肠储袋肛管吻合术中可获得与传统开腹手术同等的安全性．近期疗效优于开腹手术。

Objective To compare the outcomes of total proctocolectomy with ileal pouch-anal anastomosis performed by hand-assisted laparoscopie （HALS） and laparotomy. Methods Clinical data of 78 patients undergoing HALS （n=36） or laparotomy （n=42） from January 2009 to June 2011 were retrospectively studied. All the operations were performed by the same surgical group. Patients safety, postoperative recovery, complications were compared between the two groups. Results As compared to laparotomy group, HALS group had longer operative time [（300.3±56.4） min vs. （227.2＋34.0） min, P=0.001], less intraoperative bleeding [（150.2±42.2） ml vs. （213.5±61.0） ml, P=0.043], shorter interval to first flatus [（2.4±0.9） d vs. （3.1±1.2） d, P=0.026], and shorter hospital stay [ （9.3±2.6） d vs. （11.6±3.4） d, P=0.039]. There were no significant differences in the incidence of complications such as anastomotic separation, hemorrhage, wound infection, pelvic sepsis, and intestinal obstruction between the two groups （P〉0.05）. Conclusions HALS is as safe as open approach for total proctocolectomy with ileal pouch-anal anastomosis, and short-term outcomes are better than laparotomy.