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Analysis of Risk Factors for Conversion of Single Incision Laparoscopic Surgery for Colorectal Disease

分析無法以單孔腹腔鏡完成大腸直腸手術的風險因素

摘要


Purpose. This study is to purpose the risk factors for conversion of single incision laparoscopic surgery (SILS) for colorectal disease. Methods. Between March 2010 and March 2015, all patients who received single incision laparoscopic colorectal surgery by a single surgeon were retrospectively reviewed. The demographics, operation procedure and perioperative data were all recorded. Results. 272 patients were enrolled (206 patients in SILS group and 66 patients in conversion group). The two groups did not differ significantly in age, gender, American Society of Anesthesiology (ASA) score and patients who received previous abdominal or pelvic surgery. The average BMI is lower in SILS group. The operation time was longer and more blood loss in conversion group (167.5 vs. 216.7 minutes, p < 0.001 and 35 vs. 64 ml, p = 0.013, respectively). The average tumor size was almost equal but wound length was slightly longer in conversion group. In surgical procedure, most right hemicolectomies were done with SILS and most low anterior resections were converted to reduced port laparoscopic surgery. In obese patient, 44% of them were converted to reduced port laparoscopic surgery. Conclusions. Our study demonstrates that middle to low rectal cancer and obesity are the risk factors for conversion of single incision laparoscopic surgery for colorectal disease. Most of these cases can be safely finished after conversion to reduced port laparoscopic surgery with inserting one or two additional ports.

並列摘要


目的 評估當使用單孔腹腔鏡來治療大腸直腸疾病時,遭遇到什麼因素將使得手術無法以單孔腹腔鏡完成。方法 自2010 年3 月到2015 年3 月間,由同一位外科醫生進行單切口腹腔鏡結直腸手術的患者進行回朔性資料審查。人口統計,手術種類及手術期相關的數據都記錄和分析。結果 這項研究納入272 例 (包含206 例以單孔腹腔鏡完成,66 例術中轉變為減孔式腹腔鏡手術) 的患者。兩組在年齡,性別,麻醉評分和接受過腹部或骨盆腔手術病史的病人數量都沒有顯著差異。病人的平均BMI 在單孔腹腔鏡組較低。在術中轉變為減孔式腹腔鏡手術這組,有較長的手術時間和較多術中失血。兩組的平均腫瘤大小相近,但額外孔洞組的平均傷口稍長。在手術術式中,右半結腸切除術幾乎都可以經由單孔腹腔鏡完成,而低位前切除術大多都需要打額外孔洞轉變成減孔式腹腔鏡手術。在肥胖的病人當中,有44% 無法以單孔腹腔鏡完成手術而轉變成減孔式腹腔鏡手術。結論 我們研究顯示中低位直腸癌及肥胖是大腸直腸手術無法以單孔腹腔鏡完成的風險因素。在這些案例中,絕大多數均可在術中額外增加孔洞轉變為減孔式腹腔鏡手術並安全地完成手術。

並列關鍵字

單孔腹腔鏡

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