Laparoscopic Surgery and Incidence of Adhesion Ileus in Patients with Right-sided Colon Cancer

腹腔鏡手術對右側大腸癌病人術後沾黏性腸阻塞發生率的影響

張奇男(Chi-Nan Chang) ； 王愷晟(Kai-Chen Wang) ； 陳宏彰(Hong-Chang Chen) ； 黃玄遠(Hsuan-Yuan Huang) ； 陳志誠(Cheng-Zhi Chen) ； 黃燈明(Ting-Ming Huang)

《中華民國大腸直腸外科醫學會雜誌》 26卷4期 (2015/12) Pp. 129-134

https://doi.org/10.6312/SCRSTW.2015.26(4).10401

摘要

目的：在腹部或骨盆手術後，沾黏反應是無可避免的，腸沾黏可能會造成許多併發症，若發生併發症，隨之而來的就是高額的醫療費用。有些關於人類或動物的研究發現腹腔鏡手術造成沾黏的發生率低於傳統開腹手術。在這篇回溯性研究中，我們比較腹腔鏡右側結腸切除與傳統開腹之間沾黏性腸阻塞的發生率。方法：本研究採回溯性分析，回顧於西元2005年一月至西元2011年十二月之間，於本院因右側大腸癌而接受右半結腸切除術的病人的手術紀錄及病歷。收錄患者主要於急診時主訴腹痛、嘔吐、或腹脹無排氣排便超過48小時，並且於電腦斷層掃描發現擴張的腸道及阻塞點位於沾黏的區域。結果：共收錄281位患者，其中傳統開腹手術164位，腹腔鏡手術117位，平均追蹤時間為66個月（範圍，24~96個月）。兩組間年齡、性別、麻醉分級類似。因沾黏性腸阻塞而住院（5.5% vs 3.4%, p=0.416）或再手術（2.4% vs 0%, p=0.089）的發生率，並無統計學上顯著差異。結論：右側結腸癌病人接受傳統開腹手術或腹腔鏡手術，於本院術後沾黏性腸阻塞的發生率，兩者並無顯著差異。

關鍵字

右側結腸癌 ； 右半結腸切除術 ； 腹腔鏡右半結腸切除術 ； 沾黏 ； 腸阻塞

並列摘要

Purpose. Adhesions are an inevitable consequence of abdominal or pelvic surgery that may cause additional complications and increase hospital costs. A number of human and animal studies have shown that laparoscopic surgery is associated with a lower incidence of adhesion formation than open surgery. In this retrospective study, we compared the incidence of adhesion ileus between patients who underwent right hemicolectomy using laparoscopy and those who received open surgery. Materials and Methods. We retrospectively reviewed the medical and surgical records of all patients who underwent elective hemicolectomy for right-sided colon cancer between January 2005 and December 2011. Adhesion ileus was suspected in patients who presented to our emergency department or outpatient department with complaints of constipation for more than 48 hours together with intermittent, painful cramping, vomiting, or abdominal distension without flatus. For these patients, computed tomography (CT) imaging showed the presence of dilated bowel loops with a transitional zone over the adhesion site. Results. There were 281 patient who underwent elective right-sided hemicolectomy using open surgery (n=164) or laparoscopy (n=117) at our institution. The mean follow-up time was 66 months (median: 53 months, range, 24-96 months). Both the groups were comparable in terms of their age, gender, and American Society of Anesthesiologists (ASA) classification. There were no significant differences in the rates of re-admission for adhesion ileus (5.5% vs 3.4%, p=0.416) or surgery for adhesion (2.4% vs 0%, p=0.089) between the open and laparoscopic groups. Conclusions. In our 281-patient cohort, our results revealed that there was no significant difference in the incidence of post-surgical adhesion ileus between patients who underwent laparoscopic-assisted surgery and patients who received open surgery for right-sided colon cancer.

並列關鍵字

Right-sided colon cancer ； Open right hemicolectomy ； Laparoscopic right hemicolectomy ； Adhesion ； Ileus

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