| Objective:Laparoscopic surgery is a minimally invasive procedure which is gradually widely used for its advantages including minimal invasion, decreased blood loss and accelerated recovery. With the progression of laaproscopic technique and the accumulation of clinical experience, laparoscopic surgery began to become a treatment of choice for patients with colorectal diseases. Total colectomy is adapted for widespread colorectal disorders. Laparotomic total colectomy would cause a large incision, massive blood loss, and long recovery period. Laparoscopic operation is at dominant position to the open approach. This study analyzed relevant clinical datum and literatures, and tried to discuss the value of laparoscopic total colectomy in colorectual diseases.Methods:A retrospective review was carried out including30cases who underwent laparoscopic total colectomy or open technique at Shandong University Qilu Hospital from year2009to2012. Of the12laparoscopic cases there were5UC patients and7FAP patients, while of the18open cases there were11UC patients and7FAP patients. Their preoperative, intraoperative and postoperative records were collected to compare the perioperative conditions and outcomes of laparoscopic total colectomy versus conventional open approach. Datum were analyzed using SPSS. Theme was disscussed in combination with literatures and analytic results.Results:Lapascopic group and open group had no significant variances in gender, age, body mass index, disease distribution and surgical type. Obviously laparoscopic group had shorter incision than open group(5.3±0.5cm versus23.3±2.0cm). There was no significant difference between laparoscopic and open approach with respect to operating time(264.4±30.7min versus254.7±26.9min). Estimated blood loss was significantly lower in the laparoscopic group than open group(116.6±35.8ml versus147±40.4ml). Postoperative narcotics were less used in laparoscopic than open gourp significantly(3/12versus13/18). Compared with open group, laparoscopic group showed earlier venting time(65.8±16.1h versus85.6±12.3h), and earlier catheter extraction(4.5±1.9d versus6.1±2.1d) significantly. It is proven that laparoscopic surgery and open approach had the similar incidence of incisional complications(1/12versus3/18) and other complications(1/12versus2/18). Laparoscopic group had less postoperative days(11.6±3.4d versus13.8±2.5d), but meant costing more money(￥49355±4803versus￥38618±3589). Six months after the operation, the two groups had comparative defaecating frequency(4.5±1.6times per day versus4.9±1.4times per day).Conclusions:Patients were able to tolerente laparoscopic surgery well, without coversion to open procedure. In accordance with intraoperative and postoperative conditions, it might be concluded that laparoscopic approach stands for minimal invasion. During the postoperative period in hospital, patients in laparoscopic group were lead to accelerated recovery in both bowl function and general condition. That the defecation frequency was satisfied, as we seen, lead to the conclusion that laparoscopic surgery can also result in acceptable quality of life. Laparoscopic surgery may be an alternative to open surgery for surgens experienced with the laparoscopic technique, as its effects are not worse than those of the latter. In a word, laparoscopic total colectomy has safety and feasibility. It is a minimally invasive and fast recuperative kind of surgery, and will be perspective in the therapy of colorectal diseases. |
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