Laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis: a new step in the treatment of slow-transit constipation
Laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis: a new step in the treatment of slow-transit constipation
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DOI：
10.1007/s00464-011-2092-4
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发表时间：
2012-06-01
影响因子：
3.1
通讯作者：
Roncoroni, Luigi
中科院分区：
文献类型：
--
作者：
Marchesi, Federico;Percalli, Luigi;Roncoroni, Luigi
结肠次全切除加逆蠕动盲肠直肠吻合术（SCCRA）已被证明是治疗严重慢传输型便秘的有效替代全结肠切除术的方法。腹腔镜方法使该手术更具吸引力。这是第一个关于腹腔镜SCCRA的对照试验。该研究比较了腹腔镜和开放approach.Methods自2001年以来，所有SCCRA已在我们的机构进行腹腔镜。只有症状严重的病人才能接受手术，经过严格的病人选择。腹腔镜SCCRA的实施步骤与我们首次描述的开放手术相同，采用五套管针技术。每3个月和6个月前瞻性收集一次结局参数。功能评定采用Wexner便秘和失禁量表（WCS，WI）和胃肠生活质量指数（GIQLI）。我们进行了一项病例对照研究，15例连续患者谁接受腹腔镜SCCRA（VL）和15例患者以前的开放式方法（Op），以比较术后和功能outcomes.Results VL组有更好的术后结果（疼痛，肠梗阻），而并发症发生率相似。两组的便秘消退情况令人印象深刻，随访时无显著差异。VL组在3个月时排便次数较多（3.8 vs. 2.8，p = 0.039），导致3个月时尿失禁率显著较高（WI 6.4 vs. 2.73，p = 0.004），尽管在1年随访时差异不再显著。两组患者的生活质量均良好; VL组在1年随访时显示出显著改善（64.18 vs. 114.79，p < 0.01）。结论腹腔镜SCCRA证实了开放手术的良好功能结果，没有增加发病率，术后恢复更快。早期较高的尿失禁率并不影响生活质量。
Background Subtotal colectomy with antiperistaltic cecorectal anastomosis (SCCRA) has proved to be an effective alternative to total colectomy for the treatment of severe slow-transit constipation. The laparoscopic approach has made this procedure even more attractive. This is the first controlled trial on laparoscopic SCCRA. The study compares the laparoscopic and the open approach.Methods Since 2001, all SCCRAs have been performed laparoscopically at our institution. Only severely symptomatic patients are offered surgery, after stringent patient selection. Laparoscopic SCCRA was performed following the same steps that we first described for the open approach, by utilizing a five-trocar technique. Outcome parameters were prospectively collected every 3 and 6 months. Wexner constipation and incontinence scales (WCS, WI) and gastrointestinal quality of life index (GIQLI) were adopted for functional results. We conducted a case-control study of 15 consecutive patients who underwent laparoscopic SCCRA (VL) and 15 patients previously operated on by the open approach (Op) to compare postoperative and functional outcomes.Results The VL group had better postoperative outcomes (pain, ileus) while complication rates were similar. Resolution of constipation was impressive in both groups, with no significant difference at follow-up. The VL group presented with a higher number of bowel movements at 3 months (3.8 vs. 2.8, p = 0.039), resulting in a significantly higher incontinence rate at 3 months (WI 6.4 vs. 2.73, p = 0.004), although the difference was no longer significant at 1-year follow-up. The quality of life was good for both groups; the VL group showed a significant improvement at 1-year follow-up (64.18 vs. 114.79, p < 0.01).Conclusions Laparoscopic SCCRA confirmed the good functional results of the open approach, with no increase in morbidity rate and a faster postoperative recovery. An early higher incontinence rate did not affect quality of life.