Laparoscopic Colorectal Surgery for Cirrhotic Patients

肝硬化病人接受腹腔鏡大腸直腸切除手術

陳相智(Hsiang-Chih Chen) ； 陳姿君(Tzu-Chun Chen) ； 洪基翔(Ji-Shiang Hung) ； 黃約翰(John Huang) ； 林本仁(Ben-Ren Lin) ； 梁金銅(Jin-Tung Liang)

《中華民國大腸直腸外科醫學會雜誌》 31卷2期 (2020/06) Pp. 75-80

https://doi.org/10.6312/SCRSTW.202006_31(2).10825

摘要

Purpose. In Taiwan, colorectal cancer is the third leading cause of cancer death and the prevalence of liver cirrhosis is high. Cirrhotic patients have higher surgical morbidity and mortality, especially in colon and rectal surgery. This study reports our experience of minimally invasive surgery for colorectal cancer patients with liver cirrhosis. Methods. Patient demographics, pre-operative laboratory data, operative data, peri-operative data, and postoperative morbidity and mortality of patients with liver cirrhosis who underwent minimally invasive surgery for colorectal cancer between January 2004 and December 2016 were retrospectively reviewed and analyzed. Results. Twenty-six patients were included. There were 21 male and five female patients. The mean age was 67.9 ± 10.8 years, and the mean body mass index was 24.4 ± 3.3 kg/m^2. The causes of hepatitis were hepatitis B virus in 14 patients, hepatitis C virus in five, alcoholic hepatitis in two, and nonalcoholic steatohepatitis in five. Twenty-two patients (84.6%) were Child-Pugh class Aand four (15.4%) were Child-Pugh class B. The mean operative time was 260 ± 68 min, and the mean estimated blood loss was 419 ± 605 mL. Six patients (23.1%) received intraoperative transfusion and one patient (3.8%) was converted to open surgery. The mean intensive care unit stay was 1 ± 1.41 days, and the mean postoperative hospital stay was 17 ± 21 days. The 30-day major morbidity and mortality rates were 26.9% and 3.85%, respectively. Conclusions. Laparoscopic colorectal surgery for patients with mild to moderate cirrhosis is feasible and safe with comparable postoperative morbidity and low 30-day mortality.

關鍵字

Colorectal cancer ； Liver cirrhosis ； Minimally invasive surgery ； Safety

並列摘要

目的：大腸直腸癌在台灣為致死率第三高的癌症，且肝硬化的盛行率於台灣仍居高不下。肝硬化病人接受手術時有較高的併發症及死亡率，尤其是接受大腸直腸相關手術。本研究報告本院肝硬化病人接受腹腔鏡大腸直腸切除手術之經驗。方法：回溯性收集2004年1月至2016年12月間於本院接受腹腔鏡大腸直腸切除手術的病人，統計人口學資料、術前實驗室檢查數據、手術數據、術中及術後數據以及術後併發症及死亡數據。結果：共納入26位病患，其中21位為男性，5位為女性。平均年齡為67.9±10.8歲，BMI為24.4±3.3。造成肝硬化的原因：14位病人為B型肝炎、5位為C型肝炎、2位為酒精性肝炎、5位為非酒精性脂性肝炎。22位病人為Child-Pugh class A肝硬化，4位為Child-Pugh class B肝硬化。平均手術時間為260±68分鐘而平均失血量為419±605毫升。6位病人術中接受輸血且有1位病人轉為開腹手術。術後平均於加護病房住院1±1.41天，平均術後住院天數為17±21天。三十天產生重度併發症率為26.9%，死亡率為3.85%。結論：輕度至中度肝硬化病人接受腹腔鏡大腸直腸切除手術是可行且安全的，因有較低的併發症率及死亡率。

並列關鍵字

大腸直腸癌 ； 肝硬化 ； 微創手術 ； 安全性

參考文獻

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