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。

Clinical study of hand-assisted laparoscopic total colectomy for colonic inertia

OBJECTIVE: To compare the efficacy of hand-assisted laparoscopic surgery (HALS) with that of open surgery (OS) in total colectomy, and to evaluate the feasibility of hand-assisted laparoscopic total colectomy for colonic inertia. METHODS: A total of 42 patients of colonic inertia received total colectomy from January 2001 to June 2006 were randomly allocated to OS group (n = 22) and HALS group (n = 20). Data as clinical manifestation, perioperative features including operative time, intraoperative blood loss and incision length, postoperative features including first flatus-passing time, first fluid-feeding time, hospitalization time, early postoperative complications, and hospitalizing expense were recorded and compared in the two groups. Postoperative defecating frequency was followed up in both groups. RESULTS: All patients underwent total colectomy successfully and no death of operation occurred. The clinical features, operative time and blood loss were similar for the two groups. Incision length, first flatus-passing time, first fluids-feeding time, hospitalization time were better in HALS group than those in OS group. But mean hospitalizing expense in HALS group was higher than that in OS group. One case of incision infection and one intestinal obstruction occurred in OS group. No complication occurred in HALS group. Patients were followed up for 2 - 14 months, in the meantime the average defecating frequency was 3.55 +/- 1.80/d. CONCLUSIONS: HALS and open total colectomy are safe, rapid and effective surgical procedures for colonic inertia. HALS can result in a better cosmetic effect and a quicker postoperative recovery.