腹腔镜与开腹全结直肠切除回肠储袋肛管吻合术治疗溃疡性结肠炎的临床疗效分析  

Clinical efficacy of laparoscopic and open total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis

作　　者：骆洋[1] 俞旻皓[1] 陈建军[1] 秦骏[1] 黄轶洲 钟鸣[1] Luo Yang;Yu Minhao;Chen Jianjun;Qin Jun;Huang Yizhou;Zhong Ming(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China Corresponding author ： Zhong Ming,Email ： drzhongming1966@ 163.com)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,200127

出　　处：《中华消化外科杂志》2018年第9期929-934,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金面上项目（81873555、81672347）;上海市卫生和计划委员会重点项目（201540031）

摘　　要：目的比较腹腔镜与开腹全结直肠切除回肠储袋肛管吻合术治疗溃疡性结肠炎的临床疗效。方法采用回顾性队列研究方法。收集2003年1月至2016年12月上海交通大学医学院附属仁济医院收治的150例行全结直肠切除回肠储袋肛管吻合术治疗溃疡性结肠炎患者的临床资料。150例患者中，87例行腹腔镜全结直肠切除回肠储袋肛管吻合术，设为腹腔镜组：63例行开腹全结直肠切除回肠储袋肛管吻合术，设为开腹组。观察指标：（1）术中及术后情况。（2）术后并发症情况。（3）随访情况。采用门诊和电话方式进行随访，了解患者术后恢复及术后并发症情况。随访时间截至2017年12月。正态分布的计量资料以x±s表示，组问比较采用t检验；计数资料组间比较采用爿。检验。结果（1）术中及术后情况：腹腔镜组患者手术时间为（306±3）min，术中出血量为（197±12）mL，术后小肠造口首次通气时间为（62．1±1．8）h，术后住院时间为（8．2±0．4）d；开腹组患者分别为（224±4）min、（308±24）mL、（75．6±2．0）h和（10．1±0．6）d，两组患者上述指标比较，差异均有统计学意义（t=16．23，4．33，5．03，2．61，P〈0．05）。150例患者术后均顺利出院。150例患者术后3～12个月均行回肠造口回纳术，其中腹腔镜组为术后（6．0±5．6）个月，开腹组为术后（6．0±4．6）个月，两组比较，差异无统计学意义（t=0．01，P〉0．05）。（2）术后并发症情况：腹腔镜组患者中，术后切口感染、尿潴留、排便次数〉4次／d分别为2、8、21例；开腹组患者分别为8、15、29例，两组患者上述指标比较，差异均有统计学意义（X2=5．25，4．37，0．96，P〈0．05）。腹腔镜组患者中，术后肠梗阻、吻合口漏、盆腔感染、储袋炎、储袋克罗恩病、回肠储袋异常增生分别为3、10、5、23、2、1例；开腹Objective To compare the short-term and long-term outcomes between laparoscopic and open total proctocolectomy with ileal pouch-anal anastomosis （IPAA） for ulcerative colitis （ UC ）. Methods The retrospective cohort study was conducted. The clinical data of 150 UC patients who underwent total proctocolectomy with IPAA in the Renji Hospital of Shanghai Jiaotong University between January 2003 and December 2016 were collected. Among 150 patients, 87 undergoing laparoscopic total proctocoleetomy with IPAA and 63 undergoing open total proctocolectomy with IPAA were respectively allocated into the laparoscopy group and open group. Observation indicators ： （ 1 ） comparisons of intra-and post-operative situations; （2） postoperative complications; （3） follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect postoperative recovery and complications up to December 2017. Measurement data with nomlal distribution were represented as ±±s and comparison between groups was analyzed using the t test. Comparison between groups of count data was analyzed using the chi-square test. Results （1） Comparisons of intra-and post-operative situations： operation time, volume of intraoperative blood loss, time of initial intestinal stoma exsufflation and duration of hospital stay were respectively （30±63） minutes, （ 197± 12） mL, （ 62. 1± 1.8） hours, （ 8.2±0. 4） days in the laparoscopy group and （224±4）minutes, （308±24）mL, （75.6±2.0）hours, （ 10. 1±0. 6）days in the open group, with statistically significant difference between groups （t = 16. 23, 4. 33, 5.03, 2. 6l, P〈 0.05）. All patients discharged successfully from hospital. All the 150 patients underwent stoma reversion of ileum at 3- 12 months postoperatively, and the average time in the laparoscopy group and open group was respectively （6. 0± 5.6）months and （6. 0±4. 6）months, with no statistically significant difference between groups （t= 0. 01, P〉 0

关 键 词：溃疡性结肠炎 全结直肠切除术 回肠储袋肛管吻合术 腹腔镜检查 疗效 

分 类 号：R656.9[医药卫生—外科学]