腹腔镜辅助右半结肠切除术治疗老年结肠癌的临床分析

目的:评估腹腔镜及开腹右半结肠切除术治疗老年结肠癌患者的短期疗效。方法:收集2010年1月至2015年3月接受右半结肠手术、年龄大于70岁的老年患者的临床资料,包括术前临床病理因素、术中情况及术后恢复及并发症情况,共110例患者,其中60例行腹腔镜手术(腹腔镜组),50例行传统开腹手术(开腹组)。结果:腹腔镜组手术时间较开腹组明显延长(P<0.0001),两组住院时间差异无统计学意义(P=0.672),开腹组术后并发症为18%,腹腔镜组为15%,差异无统计学意义(P=0.518)。结论:腹腔镜辅助右半结肠切除术治疗老年结肠癌患者的手术疗效与常规开腹手术相似,但腹腔镜组需要更长的手术时间,未减少术后并发症、缩短住院时间。     

腹腔镜全结肠切除术在家族性腺瘤性息肉病中的临床应用(附4例报道)

目的探讨腹腔镜全结肠切除术在家族性腺瘤性息肉病（FAP）中的应用价值。方法回顾性分析我院2008年1月至2009年10月期间收治的行腹腔镜全结肠切除术的4例FAP患者的临床资料,对手术安全性和术后恢复情况进行分析。结果 4例患者均顺利行腹腔镜全结肠切除术,无中转开腹,无手术并发症及死亡。腹部切口长6.0cm,手术时间300～380min（平均330min）,术中出血量90～250ml（平均160ml）。术后2～3d肛门开始排气,术后住院时间7～11d（平均9d）出院。出院后大便稀薄,8～12次/d,给予易蒙停治疗后缓解。随访2～22个月（平均14个月）,无近期并发症发生。结论腹腔镜全结肠切除术治疗FAP安全、有效,近期效果良好。     

手助腹腔镜全结肠切除术治疗结肠无力症的临床研究

目的比较手助腹腔镜与开腹全结肠切除术的临床疗效,评价手助腹腔镜全结肠切除术在结肠无力症手术治疗中的应用价值。方法采用前瞻性随机对照研究的方法,将2001年1月至2006年6月收治的42例结肠无力症患者分为传统开腹手术（22例）和手助腹腔镜手术（20例）两组,比较两组患者的一般临床资料、手术情况（手术时间、出血量、切口长度）、术后情况（肛门排气时间、进流质时间、术后平均住院日、术后早期并发症以及费用）,并随访术后排便情况。结果开腹组与手助腹腔镜组一般临床资料无明显差别。42例均行全结肠切除术,无手术死亡。两组的手术时间、术中出血无明显差别;但两组的手术切口长度、术后肛门排气时间、进流质时间和术后平均住院天数差异有统计学意义（P〈0．05）,手助腹腔镜组优于传统开腹手术组;但平均住院费用手助腹腔镜组高于开腹组（P〈0．05）。开腹组1例发生切口感染,1例出现早期肠梗阻。手助腹腔镜组术后无明显并发症。术后随访2～14个月,两组平均排便（3．55±1．80）次／d。结论手助腹腔镜与开腹全结肠切除术均安全、简捷、有效,前者更有手术外观好、术后恢复快的优点。     

腹腔镜与开腹结肠憩室切除术的疗效对比

目的:比较腹腔镜与开腹结肠憩室切除术的临床疗效.方法:将43例结肠憩室患者随机分为腹腔镜组和开腹组,对比两组手术时间、术后4d疼痛评分、肛门排气排便时间、术后并发症发生率及术后住院时间.结果:两组手术时间、术后疼痛及术后并发症发生率等方面差异无统计学意义,术后排气排便时间及住院时间差异有统计学意义.结论:腹腔镜结肠憩室...     

腹腔镜与开腹全结肠切除术治疗家族性息肉病的疗效比较

目的:比较腹腔镜下全结肠切除术和传统开腹术在治疗家族性息肉病的安全性与有效性。方法:回顾性分析2003年1月—2011年1月间收治的家族性息肉病患者56例的临床资料,按术式将患者分为腹腔镜组(31例)和传统开腹组(25例),比较两组术前、术中及术后情况。结果:两组术前一般资料具有可比性(P>0.05);两组术中失血量无明显差异,均无输血(均P>0.05),腹腔镜组平均手术时间长于开腹组(330 min vs.160 min)(P<0.05);术后,两组除胃肠道恢复时间无统计学差异外(P>0.05),与开腹组比较,腹腔镜组术后并发症发生率(0 vs.24%),止痛药使用例数(0 vs.6),平均住院时间(8 d vs.14 d)及术后前3天平均引流量(30 mL vs.100 mL)均明显减少(均P<0.05);术后3个月,腹腔镜组未见复发,而开腹组3例复发(P<0.05)。结论:腹腔镜下全结肠切除术可以安全有效地治疗家族性息肉病,且较开腹术在生活质量和远期疗效方面存在优势。     

腹腔镜次全结肠切除术治疗慢性传输性便秘的的护理体会

目的:提供腹腔镜下次全结肠切除术的护理经验.方法:回顾性分析我院2002-2007年接受次全结肠切除术的28例慢传输型便秘患者,分为开腹组(13例)和腹腔镜组(15例),比较两组病人的一般情况、手术情况、术后情况以及疗效评价.结果:28例均行结肠次全切除术,两组病人一般情况、手术时间、术后肠道功能恢复时间以及便秘症状改善率无差异,但腹腔镜组在术后止痛剂使用次数(2.3±0.9)、引流管引流量(38.9±8.9/d)、伤口并发症[1]及术后住院时间(13.1±1.7)等方面均优于开腹组.结论:腹腔镜行结肠次全切除术治疗慢传输型便秘安全、有效、可行,应不断完善其护临床理.     

腹腔镜与剖腹急诊结肠切除术治疗穿孔性结肠憩室炎疗效对比的Meta分析

目的:应用Meta分析的方法,对比腹腔镜与传统剖腹结肠切除术治疗穿孔性结肠憩室炎的近期效果。方法:检索PubMed、Embase、Cochrane Library、中国知网与万方数据库已公开发表的有关腹腔镜与剖腹结肠切除术治疗穿孔性结肠憩室炎近期效果对比研究的临床文献。采用R软件与RevMan 5.3软件对符合条件的结果进行Meta分析。结果:共纳入7篇文献、11 540例患者,其中腹腔镜组2 449例,剖腹组9 091例。腹腔镜组术后并发症发生率、术后死亡率、术后住院时间低于剖腹组,手术时间长于剖腹组。腹腔镜组中转开腹率为33%。两组非计划再手术率差异无统计学意义。结论:腹腔镜结肠切除术治疗穿孔性结肠憩室炎的手术效果并不劣于剖腹手术。由经验丰富的外科医师施术,可能取得较剖腹手术更好的效果。     

腹腔镜下全结肠切除治疗多原发结肠癌3例

目的:探讨腹腔镜下全结肠切除术的可行性和安全性。方法:回顾分析腹腔镜全结肠切除术3例的临床资料。3例均为多原发结肠癌,在腹腔镜辅助下行全结肠切除术,并行肿瘤区域淋巴结清扫、回肠直肠吻合术。结果:3例手术顺利完成,无中转开腹,无手术死亡。平均手术时间300min(270～330min),平均出血量110ml(80～150ml),辅助切口平均长度6cm(5～7cm),平均术后住院8d(7～10d),无手术并发症。术后随访3例患者6～18个月,其中1例术后2个月出现肝内多发转移癌和脾转移癌,行B超介入射频治疗和静脉联合化疗后至今存活。结论:腹腔镜辅助全结肠切除术治疗多原发结肠癌安全可行,近期疗效良好。     

完全性腹腔镜全结肠切除治疗家族性腺瘤性息肉病(附8例报告)

目的:探讨腹腔镜完全性全结肠切除术治疗家族性腺瘤性息肉病(fam ilial adenom atous polyposis,FAP)的可行性与安全性。方法:应用腹腔镜全结肠切除术治疗家族性腺瘤性息肉病8例,总结手术过程及术后恢复情况。结果:8例手术均获成功,下腹部正中切口长度平均为5 cm,手术时间260~340m in,术中失血约80~350m l。术后2~3d排便排气,住院时间6~10d。随访2~3个月无近期并发症发生。结论:腹腔镜完全性全结肠切除治疗FAP创伤小、恢复快,安全、可行,但尚需进一步的手术病例积累。     

腹腔镜和开腹结肠切除手术治疗先天性巨结肠临床观察

目的 比较经腹腔镜结肠切除术及传统开腹结肠切除术治疗先天性巨结肠的疗效.方法 2009年4月至2010年12月我科收治先天性巨结肠患儿104例,分为两组,腹腔镜结肠切除术组70例,开腹结肠切除术组34例,比较两组患儿术前一般情况、术中情况、术后并发症及术后1年的排便情况.结果 左半结肠切除手术,腹腔镜组和开腹组治疗患儿的年龄和体重差异有统计学意义(P<0.05);无论是左半结肠切除还是次全结肠切除手术,腹腔镜组的术中出血均比开腹组明显减少(P<0.05);次全手术开腹组比腹腔镜组手术时间要短(P<0.05).两组术后并发症发生率差异无统计学意义,发生小肠结肠炎腹腔镜组12.8%,开腹组为17.7%.术后1年随访两组间情况差异无统计学意义.结论 腹腔镜手术治疗先天性巨结肠,不仅能获得传统开腹手术同样的效果,而且减小了手术对患儿的创伤,在伤口美观方面使患儿获益.     

Laparoscopic versus open sigmoid colectomy for diverticulitis

This study compared laparoscopic with open sigmoid colectomy for patients with a diagnosis of diverticulitis. Increased use of less invasive techniques makes it vitally important to evaluate outcomes of these techniques as compared with standard open procedures. Patients undergoing sigmoid colectomy for diverticulitis without hemorrhage (code 56211) between January 1997 and December 2001 were reviewed. Two groups were identified: those undergoing open sigmoid colectomy and those undergoing laparoscopic sigmoid colectomy; American Society of Anesthesiologists (ASA) scores, operative time, intensive care unit (ICU) and hospital length of stay, morbidity/mortality, and hospital charges were compared. During the study period 271 sigmoid colectomies were performed for diverticulitis without hemorrhage: 56 laparoscopically and 215 with the standard open technique. Four patients required conversion from laparoscopic to open colectomy. Mean ASA scores were: open group 2.4; laparoscopic group, 1.9 (P < 0.001). Mean operative times were: laparoscopic group, 170 +/- 45 minutes; open group, 140 +/- 49 minutes (P < 0.001). In the open group 39 patients required transfer to the ICU; one patient in the laparoscopic group required transfer to the ICU. Average hospital lengths of stay for the open and laparoscopic groups were 9.06 and 4.12 days, respectively (P < 0.001). Complications were recorded in 57 (27%) of 215 patients who underwent an open procedure versus 5 (9%) of 56 patients who underwent laparoscopic sigmoid colectomy (P < 0.01). There were three deaths in the open group and none in laparoscopic group. Average total hospital charges were 25,700 dollars for open sigmoid colectomy and 17,414 dollars for laparoscopic colectomy. Laparoscopic sigmoid colectomy compares favorably with open sigmoid colectomy for patients with a diagnosis of diverticulitis.     

经脐单孔腹腔镜、多孔腹腔镜及开腹结肠切除术间的比较

目的：比较经脐单孔腹腔镜与传统多孔腹腔镜及开腹结肠切除术手术效果。 方法：回顾性分析2011年1月—2012年12月34例经脐单孔结肠切除术患者（单孔组）与同期22例传统多孔腹腔镜结肠切除术（多孔组）和70例开腹结肠切除术患者（开腹组）资料。比较各组围手术期指标、手术效果和生活质量。 结果：3组患者一般临床资料差异无统计学意义（均P>0.05）。多孔组的手术时间明显长于单孔组与开腹组（均P<0.05）,但后两组间差异无统计学意义（P>0.05）;在失血量、切口长度、术后疼痛指数、排气时间、进流食时间、术后首次下床时间、术后住院时间等方面,单孔组和多孔组均优于开腹组（均P<0.05）,但单孔组与多孔组间差异均无统计学意义（均P>0.05）;3组间围手术期花费、术后并发症发生率及复发率差异均无统计学意义（均P>0.05）;单孔组与多孔组术后对伤口的美容指数和身体自我感知指数均较开腹组高（均P>0.05）,且单孔组美容满指数高于多孔组（P<0.05）。 结论：腹腔镜结肠手术与开腹手术治疗效果相似,但具有微创、恢复快、对生活质量影响小等优势。就美容效果而言,单孔腹腔镜手术最佳。     

Is laparoscopic subtotal colectomy better than open subtotal colectomy in children?

Purpose: The role of laparoscopic colectomy is not defined clearly. The aim of this study was to compare clinical outcomes of laparoscopic versus open subtotal colectomy in children with inflammatory bowel disease. Methods: Eight consecutive patients undergoing laparoscopic subtotal colectomy were compared with 10 consecutive patients undergoing open subtotal colectomy. All patients were refractory to medical management on immunosuppressive regimens. Operating time, length of postoperative stay and intravenous narcotic use, time to return of intestinal function, and perioperative complications were compared between the groups. Results: Operating times were significantly longer in the laparoscopic group (mean laparoscopic, 4 hours 40 minutes v mean open 2 hours 25 minutes; P [lt ] .01). There was no difference between the 2 groups in length of postoperative intravenous narcotics or hospital stay. Ileostomy output occurred earlier (mean laparoscopic, 2.5 days v mean open 3.8 days; P = .01), and there was a trend toward earlier oral intake in the laparoscopic group. A total of 6 complications occurred in 4 patients in the laparoscopic group compared with 5 complications in 5 patients in the open group. Conclusions: Perioperative clinical outcomes, including complication rates, are similar with laparoscopic and open subtotal colectomy. Laparoscopic subtotal colectomy can be performed safely in children with improved cosmesis.     

Laparoscopic total colectomy and ileorectal anastomosis (IRA), supported by an enhanced recovery programme in cases of familial adenomatous polyposis

Aim Familial adenomatous polyposis (FAP) is associated with an almost 100% chance of colorectal cancer by the age of 50 years. Surgery is the only prophylaxis. The study compared the outcome of prophylactic laparoscopic colectomy and ileorectal anastomosis (IRA) with conventional open surgery. Method A case–control study was carried out including all cases of proven FAP undergoing prophylactic laparoscopic colectomy with IRA between 1 April 2006 and 31 March 2008 using a standardized technique within an enhanced recovery programme (ERAS). All data were collected prospectively. Controls were identified retrospectively from patients who underwent open prophylactic IRA before 31 March 2008 and were matched for age, gender, BMI and ASA. Outcomes included duration of surgery, complications, length of stay, readmission and mortality. Results During the study period 25 patients underwent laparoscopic IRA. The median operating time was longer in the laparoscopic group (235 vs 180 mins, P < 0.0001) but the median hospital stay was shorter (6 vs 9 days, P = 0.002). Overall there were fewer complications in the laparoscopic group (20%vs 40%, P = 0.3). Conclusion Laparoscopic prophylactic colectomy with IRA in FAP is safe and feasible, and combined with ERAS leads to accelerated recovery and possibly fewer complications than open surgery. FAP patients undergoing prophylactic IRA should be offered laparoscopic surgery.     

腹腔镜辅助全结直肠切除术治疗家族性腺瘤性息肉病9例报告

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:回顾分析为9例FAP患者行腹腔镜辅助全结直肠切除术的临床资料,总结手术经验,并观察其安全性、术后患者康复情况及短期随访结果。同期5例开腹全结直肠切除术患者作为对照组。结果:9例患者均顺利完成手术,无中转开腹及术中并发症发生;手术时间160～250 min,平均195.56 min,略长于开腹组;术中出血量50～300 ml,平均138.89 ml,与开腹组相比,差异无统计学意义;切口长度4～6 cm,平均5.11 cm,术后肠功能恢复时间2～4 d,平均2.78 d,显著优于开腹组;术后住院7～20 d,平均12.11 d,与开腹组差异无统计学意义。术后1例低位吻合患者出现吻合口漏,余均无严重并发症发生。随访7～40个月,无肿瘤局部复发、远处转移及死亡。结论:具有丰富的腹腔镜及开腹手术经验的术者行腹腔镜辅助全结直肠切除术安全、可行,患者创伤小,康复快,近期效果良好,但尚需进一步的病例积累及随机对照研究。     

Gasless laparoscopic surgery for ulcerative colitis and familial adenomatous polyposis

PURPOSE: We evaluated the data on initial experience of gasless laparoscopic surgery for patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). PATIENTS AND METHODS: Seven patients (male/female = 3:4, median age 23, UC/FAP=5:2) underwent gasless laparoscopic total (procto) colectomy. Our basic surgical procedure involved (1) a 6- to 8-cm incision made at the beginning of the operation, (2) the wound pulled upward and/or laterally by retractors, and (3) conventional surgical instruments used through the wound; occasionally laparoscopic assistance and abdominal lifting were employed. The results were compared to those of 7 patients who had undergone conventional open surgery. RESULTS: Oral intake started earlier (p = 0.03) and C-reactive protein level on POD 4 was lower (p = 0.03) in the gasless group than in the control group. Duration of surgery, blood loss, requirement of analgesia, and morbidity rate were not significantly different between the groups. CONCLUSION: Our preliminary results suggest that gasless laparoscopic surgery for UC and FAP is feasible and can be an alternative method for minimally invasive surgery.     

Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery

OBJECTIVE: Comparison of outcome and costs after laparoscopic and open colectomy. SUMMARY BACKGROUND DATA: Previous studies comparing laparoscopic and open colectomy report conflicting results with regard to clinical outcome and costs. METHODS: Laparoscopic colectomy patients from a prospective database were matched for age, gender, and disease-related grouping to patients who underwent the same operation by the open approach over the same period (2000 to 2001). Data for the latter group was gathered by retrospective analysis and the 2 groups were compared for outcome and direct costs. RESULTS: Laparoscopic colectomy patients (n = 150) were compared with the same number of open colectomy patients. American Society of Anesthesiologists classification (P = 0.09), body mass index (P = 0.17), diagnosis (P = 0.12), complications (P = 0.14), and rate of readmission within 30 days (P = 0.44) were similar for both groups. Operating room costs were significantly higher after laparoscopic colectomy (P < 0.0001), but length of hospital stay was significantly lower (P < 0.0001). This resulted in significantly lower total costs (P = 0.0007) owing to lower pharmacy (P < 0.0001), laboratory (P <0.0001), and ward nursing costs (P = 0.0004). CONCLUSIONS: Laparoscopic colectomy results in significantly lower direct costs compared with open colectomy for carefully matched patients.     

Laparoscopic-assisted operation for familial adenomatous polyposis patients-two case reports.

OBJECTIVE: We describe herein the results of 2 laparoscopic operations to treat patients with familial adenomatous polyposis (FAP). METHODS: Two female FAP patients, aged 32 and 29 years old, were treated with restorative proctocolectomy and total colectomy with ileorectal anastomosis (hand-assisted laparoscopic surgery), respectively. RESULTS: The operative time was 360 minutes for the restorative proctocolectomy and 150 minutes for the total colectomy with ileorectal anastomosis. The blood loss was 500 cc for the restorative proctocolectomy and minimal for the total colectomy patient. The return of bowel movements took 3 days for each patient, and no complication occurred. Patients were discharged on the 15th and 7th postoperative days. CONCLUSION: A laparoscopic approach for restorative proctocolectomy or total colectomy with ileorectal anastomosis is safe and technically feasible, and provides good cosmesis.     

腹腔镜手术治疗食管裂孔疝及胃食管反流性疾病的临床体会

目的:探讨腹腔镜手术治疗食管裂孔疝及胃食管反流性疾病的临床疗效及安全性。方法:回顾分析2009年1月至2012年11月36例食管裂孔疝及胃食管反流性疾病患者的临床资料,20例行腹腔镜手术(腹腔镜组),16例行开腹手术(开腹组)。观察两组患者手术时间、术中出血量、术后住院时间、术后抗生素使用时间、术后胃肠道功能恢复时间及术后并发症。结果:腹腔镜组手术时间、术中出血量、术后住院时间、术后抗生素使用时间、术后胃肠道功能恢复时间及术后并发症发生率均显著优于开腹组(P<0.05)。结论:腹腔镜手术治疗食管裂孔疝及胃食管反流性疾病安全、可靠,具有广阔的临床应用前景。