評估右側大腸癌經由腹腔鏡或傳統手術切除後腸沾黏之比較

目的：在腹部或骨盆手術後，沾黏反應是無可避免的，腸沾黏可能會造成許多併發症，若發生併發症，隨之而來的就是高額的醫療費用。有些關於人類或動物的研究發現腹腔鏡手術造成沾黏的發生率低於傳統開腹手術。在這篇回溯性研究中，我們比較腹腔鏡右側結腸切除與傳統開腹手術之間沾黏性腸阻塞的發生率。方法：本研究採回溯性分析，回顧於西元2005年1月至西元2011年12月之間，於本院因右側大腸癌而接受右半結腸切除術的病人的手術記錄及病歷。收錄患者主要於急診時主訴腹痛、嘔吐、或腹脹無排氣排便超過48小時，並且於電腦斷層掃描發現擴張的腸道及沾黏的區域。結果：共281位患者，接受傳統開腹手術(164)位及腹腔鏡手術(117位)在我們醫院，平均追蹤時間為66個月(範圍，24~96個月)，兩組間年齡、性別、麻醉分級類似，因沾黏性腸阻塞而住院(5.5% vs 3.4%, p=0.416)或再手術(2.4% vs 0%, p=0.089)的發生率，並無統計學上顯著差異。結論：在此研究裡我們的結論是，右側結腸癌病人，接受傳統開腹手術或腹腔鏡手術，於本院術後沾黏性腸阻塞的發生率，兩者之間並無顯著差異。

Purpose: Adhesions are an inevitable consequence of abdominal or pelvic surgery. It may induce many complications and is also associated with increased hospital costs. A number of human and animal studies have shown that laparoscopic surgery is associated with a lower incidence of adhesion formation than open surgery. In this retrospective study, we compared the incidence of adhesion ileus between patients who underwent right hemicolectomy via laparoscopy and those who received open surgery.Materials and Methods: We retrospectively reviewed the medical and surgical records of all patients who received elective hemicolectomy for right-sided colon cancer during the period January 2005 to December 2011 at the Changhwa Christian Hospital, a 1676-bed medical center in central Taiwan. Adhesion ileus was suspected in patients who presented to our emergency department or outpatient department with complaints of constipation for more than 48 hours as well as intermittent crampy pain, vomiting, or abdominal distension without flatus. we regularly perform computed tomography (CT) that showed the presence of dilated bowel loops with a transitional zone over the site of adhesion. Results : There were 281 patient received elective right-sided hemicolectomy via open surgery (n=164) or laparoscopy (n=117) at our institution. The mean follow-up time was 66 months (range, 24 – 96 mo). Both groups were comparable in age, gender and American Society of Anesthesiologists (ASA) classification. there were no significant differences in the rates of re-admission for adhesion ileus ( 5.5 vs. 3.4%, p = 0.416 ) or surgery for adhesion ( 2.4 vs. 0%, p= 0.089 ) between the open and laparoscopic groups.Conclusion : Our result was that there was no significant difference in incidence of adhesion ileus between patients who underwent laparoscopic-assisted surgery and patients who received open surgery for right-sided colon cancer.