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首页> 外文期刊>Surgical Endoscopy >Less adhesiolysis and hernia repair during completion proctocolectomy after laparoscopic emergency colectomy for ulcerative colitis
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Less adhesiolysis and hernia repair during completion proctocolectomy after laparoscopic emergency colectomy for ulcerative colitis

机译：溃疡性结肠炎腹腔镜紧急结肠切除术后完成结肠直肠切除术期间的黏附溶解和疝气修复较少

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Background: The aim of this study was to determine whether the need for adhesiolysis during completion proctectomy (CP) with ileopouch anal anastomosis (IPAA) is influenced by the surgical approach of the initial emergency colectomy for ulcerative colitis and the hospital setting. Methods: One hundred consecutive patients who underwent CP with IPAA in our center between January 1999 and April 2010 were included. Emergency colectomy had been performed laparoscopically in 30 of 52 patients at the Academic Medical Center Amsterdam and in 6 of 48 patients at referring hospitals. Case files of these patients were retrospectively reviewed. Results: Significantly more extensive adhesiolysis was performed after open compared to laparoscopic colectomy (47 vs. 6%, P < 0.001). In univariate analysis, emergency colectomy at a referring hospital was also predictive for adhesiolysis (P = 0.003), but the open approach for the initial colectomy was the only independent predictive factor for the need for adhesiolysis (P < 0.001) in a multivariable ordinal logistic regression analysis. Operating time of CP was significantly longer when limited [18 (95% CI = 0-36) min] or extensive [55 (35-75) min] adhesiolysis had to be performed. The interval to CP was longer after open colectomy and after colectomy performed at a referring hospital. Significantly more incisional hernia corrections during CP were performed after open emergency colectomy (14 vs. 0%, P = 0.024). Overall morbidity and postoperative hospital stay of CP were not related to the surgical approach or the hospital setting of the emergency colectomy. Conclusion: Laparoscopic as opposed to open emergency colectomy is associated with less adhesiolysis, fewer incisional hernias, and a shorter interval to completion proctectomy.
机译：背景：本研究的目的是确定溃疡性结肠炎的初始急诊结肠切除术的手术方式和医院环境是否对完成带回盲袋肛门吻合术（IPAA）的直肠切除术（CP）期间进行粘连溶解的需求产生影响。方法：纳入1999年1月至2010年4月在我中心接受IPAA CP治疗的连续100例患者。阿姆斯特丹学术医学中心对52例患者中的30例进行了腹腔镜紧急结肠切除术，转诊医院对48例患者中的6例进行了腹腔镜手术。回顾性分析这些患者的病例档案。结果：与腹腔镜结肠切除术相比，开放后进行了更广泛的黏附溶解（47比6％，P <0.001）。在单因素分析中，转诊医院的急诊结肠切除术也可以预测粘连（P = 0.003），但是在多变量有序逻辑学中，开放式初次结肠切除术是唯一需要粘连溶解的独立预测因素（P <0.001）。回归分析。当必须进行有限的[18（95％CI = 0-36）min]或进行广泛的[55（35-75）min]黏附溶解时，CP的操作时间明显更长。开放性结肠切除术后和在转诊医院进行结肠切除术后，CP的间隔更长。开放性急诊结肠切除术后，在CP期间进行了更多的切口疝矫正（14 vs. 0％，P = 0.024）。 CP的总体发病率和术后住院时间与手术方法或急诊结肠切除术的医院设置无关。结论：腹腔镜手术与开放式急诊结肠切除术相比，其粘连溶解少，切口疝更少，完成直肠切除术的间隔更短。

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