单孔腹腔镜在克罗恩病手术治疗中的安全性及可行性研究

doi:10.3877/cma.j.issn.1674-6899.2019.03.010

目的

单孔腹腔镜手术(single-incision laparoscopic surgery，SILS)可进一步减轻手术对患者的创伤、加快患者术后康复。本研究拟探讨SILS应用于小肠克罗恩病患者围术期应用的安全性和可行性。

方法

回顾性收集2018年1月至2019年5月于笔者所在科室行克罗恩病手术治疗的患者32例，分为2组，收集研究对象的临床资料建立数据库。对比分析试验组(SILS组)17例与对照组(传统腹腔镜手术组)15例在术中出血量、手术时间、术后肛门首次排气时间、住院费用、术后炎症指标等方面的区别。对两组患者围术期情况比较分析。

结果

17例患者成功行单孔腹腔镜小肠部分切除术，无一例中转开腹或增加切口。SILS在术中出血、术后并发症发生率、术后肛门首次排气时间、住院时间及费用等方面与常规腹腔镜手术比较，差异无统计学意义(P>0.05)。SILS的手术时间较传统腹腔镜手术有所增加[(113.3±27.2)min比(89.2±22.8)min，P<0.01]。试验组患者术后第1天及第3天外周静脉血相关炎症指标WBC、CRP及PCT等水平均低于对照组，差异有统计学意义(P<0.05)。所有患者术后无腹腔感染、腹腔脓肿及肠瘘等并发症发生。

结论

单孔腹腔镜小肠部分切除术具有和传统腹腔镜手术相当的安全性及可行性，相对于传统腹腔镜手术，SILS手术切口小且具有较好的美容效果，值得推广应用。但对术者的手术操作技术提出了更高的要求。

关键词: 单孔腹腔镜手术, 腹腔镜手术, 克罗恩病

Objective

Single-incision laparoscopic surgery (SILS) with enhanced recovery after surgery can reduce operation trauma and accelerate postoperative rehabilitation.This study aims to investigate the safety and feasibility of SILS with ERAS in the treatment of Crohn′s disease.

Methods

Total 32 patients with Crohn′s disease were randomly assigned to receive traditional laparoscopic surgery (n=15) and SILS (n=17), who underwent laparoscopic partial small intestine resection in our department were collected. Database was established and analyzed retrospectively. Additionally, intraoperative bleeding, operation time, postoperative anal first exhaust time, hospitalization expenses, postoperative inflammation index were compared between single and multiple port laparoscopic hepatectomy respectively.

Results

17 patients were performed with single port laparoscopic partial small intestine resection successfully, no case of conversion to laparotomy or adding incision. There was no clinically significant difference between two groups in terms of intraoperative bleeding, postoperative complication rate, postoperative anal first exhaust time (P>0.05). However, the operation time of single port laparoscopic was longer than the conventional laparoscopic surgery [(113.3±27.2)min vs (89.2±22.8)min, P<0.01]. There were significant differences in the postoperative hospital stay and hospitalization expenses between the two groups (P<0.05). WBC, CRP and PCT in SILS group was lower than those in the control group at the first days and the third days after operation, the differences were statistically significant (P<0.05). There was no case of postoperative abdominal infection, abscess and intestinal fistula or other complications.

Conclusion

SILS can shorten postoperative hospital stay and facilitate bowel function recovery in the treatment of Crohn′s disease. It is worthwhile to mention the nice cosmetic benefits of SILS, the perioperative SILS is safe and feasible and should be popularized in Crohn′s disease.

Key words: Single-incision laparoscopic surgery, Laparoscopic surgery, Crohn′s disease

表1 两组小肠克罗恩病患者的临床资料比较

临床资料	试验组(17例)	对照组(15例)	P值
年龄(岁， ±s)	38.5±4.3	44.5±7.1	0.08
性别(例，男/女)	9/8	8/7	0.12
BMI(kg/m², ±s)	18.4±2.5	19.1±1.7	0.06

表1 两组小肠克罗恩病患者的临床资料比较

临床资料	试验组(17例)	对照组(15例)	P值
年龄(岁， ±s)	38.5±4.3	44.5±7.1	0.08
性别(例，男/女)	9/8	8/7	0.12
BMI(kg/m², ±s)	18.4±2.5	19.1±1.7	0.06

图1 单孔腹腔镜Trocar手术装置及手术切口情况

表2 两组克罗恩病患者的术中观察指标比较( ±s)

术中观察指标	试验组(17例)	对照组(15例)	P值
手术时间(min)	113.3±27.2	89.2±22.8	0.007
术中出血量(ml)	73.5±28.7	85.5±30.1	0.103

表2 两组克罗恩病患者的术中观察指标比较( ±s)

术中观察指标	试验组(17例)	对照组(15例)	P值
手术时间(min)	113.3±27.2	89.2±22.8	0.007
术中出血量(ml)	73.5±28.7	85.5±30.1	0.103

表3 两组克罗恩病患者的术后炎症指标比较( ±s)

术后炎症指标	试验组(17例)	对照组(15例)	P值
WBC POD1(×10⁹/L)	14.3±2.1	17.2±3.6	0.020
WBC POD3(×10⁹/L)	12.6±2.9	15.8±2.3	0.031
CRP POD1(mg/dl)	12.9±3.9	19.5±3.5	0.043
CRP POD3(mg/dl)	7.1±2.7	13.5±2.3	0.013
PCT POD1(ng/ml)	0.59±0.91	1.56±0.69	0.005
PCT POD3(ng/ml)	0.24±0.46	0.72±0.83	0.028

表3 两组克罗恩病患者的术后炎症指标比较( ±s)

术后炎症指标	试验组(17例)	对照组(15例)	P值
WBC POD1(×10⁹/L)	14.3±2.1	17.2±3.6	0.020
WBC POD3(×10⁹/L)	12.6±2.9	15.8±2.3	0.031
CRP POD1(mg/dl)	12.9±3.9	19.5±3.5	0.043
CRP POD3(mg/dl)	7.1±2.7	13.5±2.3	0.013
PCT POD1(ng/ml)	0.59±0.91	1.56±0.69	0.005
PCT POD3(ng/ml)	0.24±0.46	0.72±0.83	0.028

表4 两组克罗恩病患者的术后临床指标比较( ±s)

术后临床指标	试验组(17例)	对照组(15例)	P值
术后肛门排气时间(d)	2.3±1.6	2.8±2.4	0.140
住院费用(元)	39 286.2±3 155.9	42 587.0±2 756.5	0.207
术后住院时间(d)	9.5±2.5	11.5±1.8	0.091

表4 两组克罗恩病患者的术后临床指标比较( ±s)

术后临床指标	试验组(17例)	对照组(15例)	P值
术后肛门排气时间(d)	2.3±1.6	2.8±2.4	0.140
住院费用(元)	39 286.2±3 155.9	42 587.0±2 756.5	0.207
术后住院时间(d)	9.5±2.5	11.5±1.8	0.091

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Safety and feasibility of single-incision laparoscopic surgery in the treatment of Crohn′s disease

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Safety and feasibility of single-incision laparoscopic surgery in the treatment of Crohn′s disease