腹腔镜辅助全结直肠切除术治疗家族性腺瘤性息肉病

Laparoscopic assisted total colorectal resection for familial adenomatous polyposis

目的探讨腹腔镜辅助全结直肠切除术治疗家族性腺瘤性息肉病（familial adenomatous polyposis, FAP）的安全性、可行性及应用价值。方法回顾性分析天津市人民医院2009年1月至2014年5月手术治疗的36例FAP患者的临床资料；其中腹腔镜辅助全结直肠切除术16例，传统开腹手术20例，观察两组的临床资料、手术安全性及预后情况，计量资料采用t检验，计数资料采用矿检验和Fisher确切概率法。结果腹腔镜组16例患者均顺利完成手术，无中转开腹及术中并发症。两组相比，手术时间[（178±33）min比（159±24）min，t=1．87，P=0．07]、出血量[（72±30）ml比（110±50）ml，t=-2．67，P=0．12]差异无统计学意义；但是在切口长度[（5．6±1．1）on比（15．8±1．8）cin，t=-19．5，P=0．000]、术后肠功能恢复时间[（2．7±0．9）d比（3．8±0．9）d，t=-3．7，P=0．001]、术后住院时间[（8．1±1．6）d比（9．9±1．6）d，f=-3．3，P=0．002]腹腔镜组创伤更小，恢复更快，差异有统计学意义（P〈0．05）。并发症情况：腹腔镜组吻合口瘘1例，腹腔感染1例，开腹组吻合口瘘2例，伤I：1感染2例，麻痹性肠梗阻1例，（Fisher’s Exact Test P=0．42）差异无统计学意义。随访时间6～56个月，无肿瘤复发、远处转移及死亡。结论具有丰富腹腔镜和开腹经验的术者行腹腔镜辅助全结直肠切除术更加安全、可行。

Objective To evaluate the safety, feasibility and value of treating familial adenomatous polyposis （FAP） with laparoscopic assisted total colorectal resection. Methods Thirty six patients with familial adenomatous polyposis from June 2009 to May 2014 were reviewed retrospectively. 16 FAP patients underwent laparoscopic assisted total colorectal resection and 20 FAP underwent traditional laparotomy. The clinical data, including short term follow up outcomes, safety, and recovery were analyzed retrospectively. Results Laparoscopic assisted total colorectal resection was performed successfully on 16 patients without severe complications. The mean operation time of the laparoseopie group was （ 178±33 ） min ,the mean operative blood loss （72±30 ）ml in the laparoseopic group were not significantly different when compared with the mean operation time （159±24） min and the mean operative blood loss （110±50） ml in the conventional group. Incision length （ 5.6±1.1 ） cm, the intestinal function recovery time （ 2. 7±0. 9） d, hospital stay after surgery （8. 1±1.6） d in the laparoseopic group were significantly different when compared with incision length （ 15.8±1.8） cm, the intestinal recovery time （3.8 20. 9） d, hospital stay after surgery （9. 9 ±1.6 ） d in the conventional group （ P 〈 0. 05 ）. There was no severe complications in neither group nor local recurrence, distant nletastases or death found during the follow-up of 6 - 56 months. Conclusions Laparoscopic assisted total colorectal resection for FAP can be performed safely and effectively with the advantages of minimal invasion, quick recovery and good short term effect.