Hand-assisted laparoscopic colorectal resections:the preferred option

作者对1995年至2009年间该院的微创结直肠手术进行了总结和综述,2002年后,作者开始实施手辅助下腔镜结直肠手术。在这14年间,一共实施了155例开腹手术,225例全腔镜手术和504例手辅助腔镜结肠手术。全腔镜组和手辅助组总的手术并发症发生率是2.9%,其中全腔镜组为5.3%,手辅助组为1.8%。吻合口瘘发生率在开腹组、全腔镜组和手辅助组分别为1.9%(3/155)、1.3%(3/225)和1.3%(7/504)。开腹组、全腔镜组和手辅助组的平均住院天数分别为6.4 d、3.1 d和2.9 d。腔镜组住院时间的缩短抵消了手术费用的增加,腔镜组的总费用明显少于开腹组(平均节省5053美元)。得益于手术时间的缩短和较少的器械费用,手辅助组的成本效益(7334美元)甚至优于全腔镜组(4215美元)。结果显示微创手术在并发症发生率、住院时间和总费用方面优于开腹手术,而且与开腹手术相比,手辅助下腔镜手术不仅具有腹腔镜手术的先天优势,而且手术时间更短,费用更少。

This review summarizes the author＇s series in minimally-invasivecolorectal procedures from 1995 to 2009. The author had transitioned from performing laparoscopic-assisted （LAC） to hand- assisted （HALC） colectomies in 2002. Over this fourteen-year period, the distribution of the types of colorectal procedures were as follows： 155 open, 225 laparoscopic-assisted, and 504 hand-assisted laparoscopic colectomies. Rate of overall complication was 2. 9% for the laparoscopic colectomy group （5.3% for LAC;1.8% for HALC） ;and 9.6% for open colectomy. Motic leak rate of 1.9% （3/155） for open ; 1.3% （3/255） for LAC ; and 1.3 % （7/504） for HALC. Average length of hospital stay was 3.1 days for LAC and 2. 9 days for HALC. Average length of hospital stay for open colectomy was 6. 4 days. The shortened stay for the laparoscopic colectomy group offset the increased cost of operation. Final cost analysis showed a significant benefit of the laparoscopic colectomy group as compared to open （average savings of $5 053 USD ）. The final cost-benefit was even greater for HALC （ $7 334 USD ） over LAC （ $4 215 USD）,resulting from HALC＇s shorter operatin gtimes and lower surgical equipment costs. These results suggest that minimally-invasivecolorectal procedures as compared to open have fewer complications, shorter length of stay, and lower overall cost. In addition, these results show that HALC retains all benefits of LAC procedures as compared to open;and less operating time and reduced costs when compared directly to LAC.