缺血性大腸炎的腹腔鏡與傳統急診結腸切除手術：傾向評分匹配比較

缺血性大腸炎（IC）是最常見的腸道缺血類型，其特徵為大腸的血液供應和氧氣輸送不足。手術為缺血性大腸炎主要治療方式但手術後的死亡率甚高，可達60%，通常與全大腸壞死和患者多重共病因子有關。腹腔鏡手術相對傳統剖腹的優點在一般常規手術已經得到了很好的論證。然而，緊急腹腔鏡結直腸手術尚未獲得普遍接受。其原因包括手術技巧性高、對所有病因和患者預後的不確定性、手術病人生命徵象不穩定、手術時間較長、手術中腸脹氣和廣泛的糞便性腹膜炎影響手術視野。關於腹腔鏡治療缺血性大腸炎的文獻甚為稀少，大多數患者仍接受傳統剖腹手術。本研究的目的是報告腹腔鏡治療缺血性大腸炎患者的短期結果，並與傳統剖腹方式進行傾向性評分匹配組的比較。從2011年到2020年共有109位病人進行缺血性大腸炎相關手術，排除5位病人是常規手術和8位病人沒有進行大腸切除手術，最後96位病人納入本研究當中，其中57位接受傳統剖腹手術、39位進行腹腔鏡手術。傳統剖腹手術組的病人出現更多的傷口併發症（52.6% vs. 23.0%，p = 0.004）、更多腹腔內膿瘍（47.3% vs. 17.9%，p = 0.003）、需要更長時間的呼吸器支持（20天 vs. 0天，p < 0.001）、更多重大併發症（77.2% vs. 43.5%，p = 0.001）、較高的死亡率（49.1% vs. 20.5%，p = 0.004），以及較長的住院天數（32天 vs. 19天，p = 0.001）。在進行傾向分數配對後（每組各31位病人），接受開腹手術的病人（與腹腔鏡手術相比）仍出現較多傷口併發症（45.1% vs. 19.4%，p = 0.030），並且需要較長的呼吸器支持天數（14天 vs. 3天，p = 0.039）。經多變量分析後，Charlson共病指數（p = 0.024）、APACHE II評分（p = 0.001）以及Favier分類（p = 0.023）被確認為死亡率的獨立預測因子。腹腔鏡緊急大腸切除術用於缺血性大腸炎是可行且安全的，與剖腹手術相比，術後傷口併發症較少，且需要呼吸器支持的天數較短。然而，重大併發症與死亡率仍然偏高，主要是因為病情嚴重以及病人的整體狀況。我們可以推測，對於需要手術治療的缺血性大腸炎患者而言，腹腔鏡大腸切除術的優勢可能有助於降低其併發症與加速術後恢復，但這一推測仍需透過更大規模、理想情況下為隨機分配的研究來證實。

Ischemic colitis (IC) is the most common type of intestinal ischemia, characterized by insufficient blood supply and oxygen delivery to the colon. In cases requiring surgery for ischemic colitis, the postoperative mortality rate can be as high as 60%, typically associated with transmural bowel necrosis and multiple patient comorbidities. The advantages of laparoscopic surgery over traditional open laparotomy have been well documented in elective procedures. However, emergency laparoscopic colorectal surgery has not yet gained widespread acceptance. This is due to factors such as a steep learning curve, uncertainty regarding disease etiology and patient prognosis, hemodynamic instability in emergency cases, longer operative times, bowel distension, and the presence of extensive fecal peritonitis. Literature on laparoscopic management of ischemic colitis remains scarce, with most patients still undergoing open surgery. The purpose of this study is to report short-term outcomes of laparoscopic surgery for ischemic colitis and compare them with outcomes of open surgery using a propensity score-matched analysis. Patients in the open surgery group experienced significantly more surgical site complications (52.6% vs. 23.0%, p = 0.004), more intra-abdominal abscesses (47.3% vs. 17.9%, p = 0.003), longer ventilator support duration (20 days vs. 0 days, p < 0.001), more major complications (77.2% vs. 43.5%, p = 0.001), higher mortality (49.1% vs. 20.5%, p = 0.004), and longer hospital stays (32 days vs. 19 days, p = 0.001). After propensity score matching (31 patients in each group), the open surgery group still had more surgical site complications (45.1% vs. 19.4%, p = 0.030) and required longer ventilator support (14 days vs. 3 days, p = 0.039). Multivariate analysis identified the Charlson Comorbidity Index (p = 0.024), APACHE II score (p = 0.001), and Favier’s classification (p = 0.023) as independent predictors of mortality. Emergency laparoscopic colectomy for ischemic colitis is feasible and safe. Compared to open surgery, it is associated with fewer postoperative surgical site complications and shorter ventilator support duration. However, major complications and mortality rates remain high, primarily due to disease severity and overall patient condition. It can be postulated that laparoscopic colectomy may reduce morbidity and enhance recovery in this patient population, but this hypothesis requires validation through