Laparoscopic Total Colectomy: A New Surgical Alternative for Colon Inertia

大腸無力症的另一種外科治療方法：腹腔鏡大腸全切除術

游耀東(Yau-Tong You) ； 王正儀(Jeng-Yi Wang) ； 張簡俊榮(Chung-Rong Changchien) ； 陳進勛(Jinn-Shiun Chen) ； 唐瑞平(Rei-Ping Tang) ； 江支銘(Jy-Ming Chiang) ； 葉建裕(Chien-Yuh Yeh) ； 謝寶秀(Pao-Shiu Hsieh) ； 蔡文司(Wen-Sy Tsai) ； 游正府(Jeng-Fu You) ； 洪欣園(Hsin-Yuan Hung)

《Formosan Journal of Surgery》 44卷3期 (2011/06) Pp. 95-102

https://doi.org/10.29833/FJS.201106.0002

摘要

目的：腹部大腸全切被認爲是治療大腸無力症的一種治療，但是術後的併發症，如：腸阻塞、傷口感染、長的傷口疤痕常困擾病人。最近腹腔鏡已被用來做大腸病的切除，它是一種微創外科手術，本研究的目的：在比較腹腔鏡大腸全切除與開腹大腸全切除來治療大腸無力症，兩者問的優劣。病人與方法：從2005年1月至2009年1月共收集80個大腸無力症病人，分為兩組：組1,38個病人接受腹腔鏡大腸全切除：耀，42個病人接受開腹大腸全切除，兩組與每個人收隻的資料包括：年齡、姓別、手術失血量、手術時間、術後至進食的時間、術後併發症、住院時間、術後止痛藥的使用量、傷口的大小…等。做爲兩者間的比較。結果：手術前後的結果，包括：手術失血量(group I: 87.1±27.4 ml vs group II: 127.9±30.8 ml)、傷口大小(group I: 4.5±0.2 cm vs group II: 23.7±1.4 cm)、住院時間(group I: 6.3±1.3 days vs group II: 8.4±1.6 days)、術後止痛藥的使用量(group I: 1.7±0.5 days vs group II: 2.8±0.5 days)等，在組l的病人皆比組2的病人好，且術後併發症的發生，組1的病人也比較低。結論：從本研究的結果發現，用腹腔鏡大腸全切除治療大腸無力症是一個比較好的選擇。

並列摘要

Objective: Abdominal total colectomy is recognized as a therapeutic option for patients with intractable constipation due to colonic inertia. However, postoperative complications such as intestinal obstruction, wound infection, long scars of the abdominal wound may bother the patients. Recently, laparoscopic colectomy for colon lesions has become an increasingly accepted procedure. It has been reported to have many advantages because of its minimal invasiveness. The aims of this study were to compare difference between laparoscopic colectomy and open colectomy in the treatment of colon inertia, to assess the safety of this laparoscopic approach and to determine whether the proposed advantages hold true.Methods: Eighty colon inertia patients were collected from January 2005 to January 2009. They were divided into 2 groups. Group I consisted of 38 patients who underwent laparoscopic total abdominal colectomy with ileorectal anastomosis. Group II consisted of 42 patients who underwent open total abdominal colectomy with ileorectal anastomosis. The data collected from participants in the study included age, gender, intraoperative estimated blood loss, median operative time, time at which a clear liquid diet was started, postoperative morbidities, mean length of hospital stay, postoperative narcotic usage, and incision length in both groups. The two groups were compared on the basis of these data.Results: The perioperative and postoperative outcomes including intraoperative estimated blood loss, (group I: 87.1±27.4 ml vs group II: 127.9±30.8 ml) length of surgical incision (group I: 4.5±0.2 cm vs group II: 23.7±1.4 cm), mean length of hospital stay (group I: 6.3±1.3 days vs group II: 8.4±1.6 days), and narcotic usage for postoperative wound pain (group I: 1.7±0.5 days vs group II: 2.8±0.5 days) in group I were significantly superior to those in group II. The incidence of complications was also significantly lower in group I than that in group II. Conclusions: From our results, it can be said that laparoscopic total colectomy was the better surgical alternative for colon inertia.

並列關鍵字

colon inertia ； laparoscopic total colectomy