Laparoscopic redo surgery in recurrent ileocolic Crohn's disease: A standardised technique.
Laparoscopic redo surgery in recurrent ileocolic Crohn's disease: A standardised technique.
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DOI：
10.4103/jmas.jmas_144_18
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发表时间：
2020-01
影响因子：
0.8
通讯作者：
Celentano V
中科院分区：
文献类型：
--
作者：
Celentano V
尽管克罗恩病 (CD) 的医疗管理取得了许多进展，但由于医疗管理缺乏反应或患者一生中出现并发症，手术切除的风险仍然很大。腹腔镜手术具有短期效益，例如减轻疼痛、降低伤口并发症发生率、更早恢复饮食和肠道功能、更好的美容效果和更短的住院时间，而减少术后粘连和降低切口疝发生率可能代表长期效益。模块化、标准化的腹腔镜方法可用于在 CD 复发的恶劣环境下安全地进行腹腔镜重做手术，并促进这些高级手术的教学和培训。 CD 的腹腔镜手术尤其具有挑战性，因为具有广泛炎症和增厚的肠系膜的多病灶疾病，可能出现脓肿、瘘管和蜂窝织炎，并且据报道，在复发性 CD 的再次手术中，脓肿和粘连是转化的主要原因，且转化率很高。已经描述了用于复发性 CD 重做手术的标准化腹腔镜方法。 CD 的多学科治疗至关重要，并且必须优先考虑保护肠道。
Despite many advances in the medical management of Crohn's disease (CD), there is still a significant risk of surgical resection for lack of response to medical management or complications during the lifetime of a patient. Laparoscopic surgery offers short-term benefits such as decreased pain, lower wound complication rates, earlier resumption of diet and bowel function, better cosmesis and shorter hospital stays, while reduced post-operative adhesions and lower incisional hernia rate may represent long-term benefits. A modular, standardised laparoscopic approach can be applied to safely perform laparoscopic redo surgery in the hostile setting of the recurrent CD and to facilitate teaching and training of these advanced procedures. Laparoscopic surgery in CD can be particularly challenging due to multifocal disease with extensive inflammation and a thickened mesentery, the potential for abscesses, fistulas and phlegmons and high conversion rates have been reported in reoperative surgery for recurrent CD with abscesses and adhesions representing the main reasons for conversion. A standardised laparoscopic approach for redo surgery in recurrent CD has been described. Multidisciplinary management of CD is essential and bowel preservation must be the priority.