Petropoulos P, Nassiopoulos K, Chanson C
Abteilung für Allgemeine Chirurgie, Kantonsspital Freiburg, Schweiz.
Zentralbl Chir. 1998;123(12):1390-3.
The aim of this work is a critical analysis of our results with primary laparoscopic resection and anastomosis of the colon for diverticulitis. From October 1993 to October 1997, 171 patients with a mean age of 60 years (97 males, 74 females) have been operated laparoscopically. 95 patients were operated electively after many episodes of acute diverticulitis and 76 patients in the acute phase, of whom 11 patients presented a colovesical fistula. 6 left hemicolectomies and 165 sigmoid resections were performed. Among the sigmoid resections 11 patients with simultaneous resection of a colovesical fistula are included. The operating time for elective cases was between 130 and 280 minutes with a mean of 180 minutes, for acute cases the time was between 75 and 410 minutes with a mean of 205 minutes. The conversion-rate was 10.5%: problems with the instruments n = 2, impossibility to pass the stapler n = 4, severe diverticulitis n = 7, iatrogenic lesion of the ureter n = 1, perforation of the transverse colon by the trocar n = 1, extended adhesions n = 2, hemorrhage n = 1. The morbidity was 10%: abdominal wall hematoma n = 1, intraabdominal hematomas n = 2, wound abscesses treated surgically n = 2, conservatively treated intraabdominal abscesses n = 2, anastomotic leaks treated with open procedure n = 2, anastomotic leaks with fistulization n = 4, treated once with laparotomy and 3 times conservatively, sepsis 3 times treated conservatively. As late complications (3.5%) we experienced: a bowel obstruction in 2 patients treated with open procedure, herniation at the trocar sites in 3 cases corrected surgically and an anastomotic stenosis, that had to be reoperated after an unsuccesful dilatation. Analgetic requests have been decreased to the half in comparison to the classically operated patients. The mortality: 1 patient (0.6%) died due to a fasciitis. The duration of the hospitalisation was 8.4 days in average (3-32 days). We can conclude that laparoscopic colon resection should be considered as an adequate procedure for the treatment of inflammatory processes. A large experience in laparoscopic surgery with continuous training of the surgeon is the prerequisite.
这项工作的目的是对我们采用原发性腹腔镜结肠切除吻合术治疗憩室炎的结果进行批判性分析。1993年10月至1997年10月，171例平均年龄60岁的患者（97例男性，74例女性）接受了腹腔镜手术。95例患者在多次急性憩室炎发作后接受择期手术，76例处于急性期，其中11例出现结肠膀胱瘘。实施了6例左半结肠切除术和165例乙状结肠切除术。在乙状结肠切除术中，包括11例同时切除结肠膀胱瘘的患者。择期手术的手术时间为130至280分钟，平均180分钟；急性病例的手术时间为75至410分钟，平均205分钟。中转率为10.5%：器械问题2例，无法通过吻合器4例，严重憩室炎7例，输尿管医源性损伤1例，套管针导致横结肠穿孔1例，广泛粘连2例，出血1例。发病率为10%：腹壁血肿1例，腹腔内血肿2例，手术治疗的伤口脓肿2例，保守治疗的腹腔内脓肿2例，开放手术治疗的吻合口漏2例，形成瘘的吻合口漏4例，1例经开腹手术治疗，3例保守治疗，败血症3例保守治疗。作为晚期并发症（3.5%），我们遇到：2例患者出现肠梗阻，经开腹手术治疗；3例套管针部位疝，经手术纠正；1例吻合口狭窄，扩张失败后再次手术。与传统手术患者相比，镇痛需求减少了一半。死亡率：1例患者（0.6%）死于筋膜炎。平均住院时间为8.4天（3至32天）。我们可以得出结论，腹腔镜结肠切除术应被视为治疗炎症性疾病的一种适当方法。具备丰富的腹腔镜手术经验并持续培训外科医生是前提条件。
