腹腔镜下结肠直肠外科术式转变的后果

作     者：Gonzalez R. Smith C. D. Mason E. B.J. Ramshaw 纪泛扑(译) 史敏(校) 

作者机构：不详 MC44 McHaney Hall One Hospital Drive Columbia MO 65212 United States 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第8期

页      面：9-10页

学科分类：1002[医学-临床医学] 100211[医学-妇产科学] 100214[医学-肿瘤学] 10[医学] 

主　　题：结肠直肠切除术 腹腔镜下 外科术式 腹腔镜胆囊切除术 腹腔镜手术 开腹胆囊切除术 术式转换 阑尾切除术 开腹手术 手术方式 

摘      要：INTRODUCTION: Laparoscopic procedures converted to open approaches have been associated with higher complication rates than laparoscopic and open cholecystectomy and appendectomy. Laparoscopic colorectal resections have relatively high conversion rates compared with other laparoscopic procedures. This study was designed to evaluate outcomes of conversions compared with laparoscopic and open colorectal resections. METHODS: We reviewed 498 consecutive colorectal resections performed between 1995 and 2002. Procedures were divided into laparoscopic colorectal resections, open colorectal resections, or conversions. Demographics, underlying disease, type of procedure performed, and operative outcomes were compared between groups. RESULTS: Of the 238 laparoscopic procedures performed, 182 were completed laparoscopically and 56 (23 percent) required conversion; 260 were performed open. Conversions were associated with greater blood loss (200 (range, 50- 750) vs. 100 (range, 30- 900) ml), longer time to first bowel movement (82 (range, 40- 504) vs. 72 (range, 12- 420) hr), and longer length of stay (6 (range, 2- 67) vs. 5 (range, 2- 62) days) than the laparoscopic colorectal resections group. There was no difference in operative time, transfusion requirements, intraoperative and postoperative complications, or mortality between conversions and laparoscopic colorectal resections. Conversions resulted in fewer patients requiring transfusions (4 vs. 14 percent), shorter time to first bowel movement (82 (range, 40- 504) vs. 93 (range, 24- 240) hr), and shorter length of stay (6 (range, 2- 67) vs. 7 (range, - 180) days) than in the open colorectal resections group. There were no differences in complications or mortality between the conversion group and the open colorectal resections group. CONCLUSIONS: Laparoscopic colorectal resections has a relatively high conversion rate; however, the converted cases have outcomes similar to open colorectal resections. In fact, the converted g