Hand-assisted Laparosocopic Surgery with Subtotal Colectomy for Colonic Inertia: Early Experiences in Tri-Service General Hospital

背景　對於蠕動緩慢型便秘，次全結腸切除術併迴腸直腸接合已成為一種標準的手術治療方式。微創手術是未來手術發展的趨勢，在此，我們提供三軍總醫院以單手輔助腹腔鏡手術行次全結腸切除術來治療蠕動緩慢型便秘的早期經驗。方法　從2001年1月到2003年1月，8位至少有2年以上間歇性腹痛及便秘症狀的年輕女性在本院接受手術治療。在大腸蠕動時間測試、直肛壓力測定術及大腸鋇劑攝影檢查後確定為蠕動緩慢形便秘之診斷，經由單手輔助腹腔鏡手術併超音波手術刀的使用次全結腸被分出來體外行切除，迴腸直腸接合則由腸腔內環狀縫合器來完成。我們分析手術結果包括：手術時間、失血量、第一次排氣時間、術後住院天數、死亡及併發症。結果　平均手術時間為182.5分鐘，平均手術估計失血量為172.5毫升，平均術後的第一次排氣為2.5日，平均住院天數為6天，沒有病患轉成剖腹探查亦無手術直接造成的死亡。只有一位患者在術後第45日發生小腸阻塞，但經由剖腹探查併腸沾粘分離術後，預後良好並無復發之情形。結論　以單手輔助腹腔鏡手術行次全結腸切除術來治療蠕動緩慢型便秘是一安全可行的手術方式。

關鍵字

單手輔助腹腔鏡手術；次全結腸切除術；蠕動緩慢型便秘

並列摘要

Purpose. Subtotal colectomy and ileorectal anastomosis is the standard procedure for selected patients with slow transit constipation (STC). Today, minimally invasive approaches are being utilized in a greater number of procedures as surgeons become more familiar with the techniques involved. The aim of this study was to examine the results of hand-assisted laparoscopic surgery for subtotal colectomy in the treatment of patients with STC. Method. From January 2002 to January 2003, eight young females presented complaints of severe constipation for 2 years prior to admission. STC was diagnosed after a series of examinations including a colonic transit test, anal manometry, and barium enema. All patients underwent a hand-assisted laparoscopic subtotal colectomy and an ileorectal end-to-end anastomosis was performed using a circular stapling instrument. Outcome data analyzed included the operative time, conversion to open procedure, blood loss, time to return of flatus, length of postoperative hospital stay, and complications. Result. The mean operative time was 182.5 min (range, 150-220 min). The mean estimated blood loss was 172.5 mL (range, 100-220 mL). The mean days of first time to flatus was 2.5 days (rang, 2-3 days) and the mean hospital stay was 6 days (range, 5-7 days). These was no conversion to an open procedure and surgical mortality was zero. In the following period, only one case developed intestinal obstruction. A lyisi of adhesion was carried out for this case. Conclusion. Hand-assisted laparoscopic subtotal colectomy is a safe and feasible operation in the treatment of STC.

並列關鍵字

Hand-assisted laparosopic surgery ； Slow transit constipation ； Subtotal colectomy

國際替代計量

Hand-assisted Laparosocopic Surgery with Subtotal Colectomy for Colonic Inertia: Early Experiences in Tri-Service General Hospital

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