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首页> 外文期刊>Surgical Endoscopy >Laparoscopic vs open total colectomy: a case-matched comparative study.
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Laparoscopic vs open total colectomy: a case-matched comparative study.

机译：腹腔镜与开放式全结肠切除术：病例对照比较研究。

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BACKGROUND: Open total colectomy and ileorectal anastomosis (OTC) is a major colorectal procedure which would preclude laparoscopy in many centers because of technical difficulty and the fact that laparoscopic total colectomy (LTC) takes much longer than standard laparoscopic proctosigmoidectomy (LPS). This study compares OTC with LTC and LPS. METHODS: In this study, 34 LTC patients (May 1999 to August 2003) were matched for age, diagnosis, operative period, and procedure with patients undergoing OTC. Patients with a previous major laparotomy were excluded from the open group. Groups were compared for gender, American Society of Anesthesiology (ASA) classification, operating time, estimated blood loss, length of hospital stay (LOS), complications including readmissions, and costs. The LPS cases were picked randomly from the laparoscopic database (every eighth patient), and the OT and LOS were noted. RESULTS: The LTC and OTC groups were matched for age (mean, 31 vs 34 years; p = 0.2), sex (14 vs 13 females; p = 0.8), ASA (8/23/3/0 vs 8/22/4/0, class 1/2/3/4). The body mass index was higher in the open group (23.8 vs 27.9; p = 0.04). The operating time was significantly longer (187 vs 126 min; p = 0.0001) and the median LOS shorter in the LTC group (3 days [IQR, 2.5-5 days] vs 6 days [IQR 4-8 days]; p = 0.0001). The estimated blood loss was significantly less in the LTC group (168 [50-700] ml) vs 238 [50-800] ml); p = 0.001, but there was no significant difference in the complication (26.5% vs 38.2%; p = 0.4) readmission (11.8% vs 14.7%; p = 1.0), reoperative rates (8.8% vs 11.8%; p = 1.0), or direct costs (Dollars 4,578 vs Dollars 4,562; p = 0.3). One LTC patient died expired on postoperative day 2 of a cardiac event. Four patients (11.8%) required conversion for obesity (n = 2), adhesions (n = 1), or intraoperative hemorrhage (n = 1). The operating times were 36 min longer in the LTC group than in the LPS group (151 vs 187 min; p = 0.02), but there was no significant difference in the LOS. (3 vs 3 days, p = 0.2). CONCLUSIONS: The findings show that LTC provides a significant decrease in the LOS over OTC, with increased operating time, but without any change in other parameters. A laparoscopic approach to subtotal colectomy is recommended for suitable patients when an experienced team is available.
机译：背景：由于技术上的困难和腹腔镜全结肠切除术（LTC）比标准腹腔镜鼻窦乙状结肠切除术（LPS）需要更长的时间，开放式全结肠切除术和回肠直肠吻合术（OTC）是一项主要的结直肠手术，在许多中心都无法进行腹腔镜检查。本研究将OTC与LTC和LPS进行了比较。方法：本研究对34例LTC患者（1999年5月至2003年8月）与年龄，诊断，手术时间和接受OTC治疗的患者进行了匹配。先前有大剖腹手术的患者被排除在开放组之外。比较各组的性别，美国麻醉学会（ASA）分类，手术时间，估计失血量，住院时间（LOS），并发症（包括再入院）和费用。从腹腔镜数据库（每位第八位患者）中随机抽取LPS病例，并记录OT和LOS。结果：LTC和OTC组在年龄（平均31岁vs 34岁; p = 0.2），性别（14 vs 13女性; p = 0.8），ASA（8/23/3/0 vs 8/22 / 4/0，等级1/2/3/4）。开放组的体重指数较高（23.8 vs 27.9; p = 0.04）。 LTC组的手术时间明显更长（187比126分钟; p = 0.0001），中位LOS较短（3天[IQR，2.5-5天] vs 6天[IQR 4-8天]; p = 0.0001） ）。 LTC组的估计失血量明显减少（168 [50-700] ml）对238 [50-800] ml）; p = 0.001，但并发症发生率（26.5％vs 38.2％; p = 0.4），再入院率（11.8％vs 14.7％; p = 1.0），再手术率（8.8％vs 11.8％; p = 1.0）无显着差异。 ，或直接费用（美元4,578对美元4,562; p = 0.3）。一名LTC患者在心脏事件的术后第二天死亡。四名患者（11.8％）因肥胖（n = 2），粘连（n = 1）或术中出血（n = 1）而需要转换。 LTC组的手术时间比LPS组的手术时间长36分钟（151比187分钟; p = 0.02），但LOS没有明显差异。 （3天对3天，p = 0.2）。结论：研究结果表明，与OTC相比，LTC可以显着降低LOS，但可以增加工作时间，但其他参数没有任何变化。如果有经验丰富的团队，建议对合适的患者进行腹腔镜大肠切除术。

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