Köckerling F, Schneider C, Reymond M A, Scheidbach H, Scheuerlein H, Konradt J, Bruch H P, Zornig C, Köhler L, Bärlehner E, Kuthe A, Szinicz G, Richter H A, Hohenberger W
Department of Surgery and Center for Minimally Invasive Surgery, Hanover Hospital, Roesebeckstrasse 15, Siloah, D-30449 Hannover, Germany.
Surg Endosc. 1999 Jun;13(6):567-71. doi: 10.1007/s004649901042.
In the large bowel, resection of the sigmoid colon is the most commonly performed laparoscopic intervention because large bowel lesions often are located in this part of the bowel and the procedure technically is the most favorable one. A number of publications involving case series or the results of highly experienced individual surgeons already have confirmed the feasibility of laparoscopic resection in cases of diverticulitis. The aim of the present prospective multicentric investigation was to check the results obtained by a large number of surgeons performing laparoscopic resection of the sigmoid colon for diverticulitis in various stages of severity.
Between January 8, 1995 and January 1, 1998, the Laparoscopic Colorectal Surgery Study Group recruited 1,118 patients to the prospective multicenter study. Diverticulitis of the sigmoid colon, which accounted for 304 cases, was the most common indication for laparoscopic intervention. In most of these patients undergoing laparoscopic surgery (81.9%), the diverticulitis manifested as acute phlegmonous peridiverticulitis, recurrent attacks of inflammation, or stenosis. Complicated forms of diverticulitis in Hinchey stages I to IV and late complications of chronic diverticular disease with fistula formation and bleeding accounted for only 18.1% of the cases. For the overall group, the conversion rate was 7.2%. Patients with less severe diverticulitis (i.e., those presenting with peridiverticulitis, stenosis, or recurrent attacks of inflammation) had a conversion rate of 4.8% and the rate for complicated cases was 18.2%. Regarding laparoscopically completed interventions, 3 of 282 patients died (1.1%). In the group of patients with peridiverticulitis, stenosis, or recurrent attacks of inflammation the overall complication rate was 14.8%. The group with perforated diverticulitis in Hinchey stages I to IV or those with fistula and bleeding, the corresponding rate was 28.9%, and after conversion it was 31.8%.
Laparoscopic colorectal interventions in sigmoid diverticulitis are, for the most part, carried out as elective procedures for peridiverticulitis, stenosis, or recurrent attacks of inflammation. The conversion, complication, and mortality rates associated with these interventions are acceptable. Laparoscopic procedures in Hinchey stages I to IV sigmoid diverticulitis and in the presence of fistula and bleeding are more likely to be associated with complications, and should be carried out only by highly experienced laparoscopic surgeons.
在大肠中，乙状结肠切除术是最常施行的腹腔镜手术，因为大肠病变常位于该肠段，且该手术在技术上最为有利。一些涉及病例系列或经验丰富的个体外科医生手术结果的出版物已经证实了腹腔镜切除术治疗憩室炎的可行性。本前瞻性多中心研究的目的是检验大量外科医生对处于不同严重程度阶段的憩室炎患者施行乙状结肠腹腔镜切除术的结果。
1995年1月8日至1998年1月1日期间，腹腔镜结直肠手术研究组招募了1118例患者参与这项前瞻性多中心研究。乙状结肠憩室炎占304例，是腹腔镜手术最常见的适应证。在大多数接受腹腔镜手术的这些患者中（81.9%），憩室炎表现为急性蜂窝织炎性憩室周炎、炎症反复发作或狭窄。Hinchey Ⅰ至Ⅳ期憩室炎的复杂形式以及伴有瘘管形成和出血的慢性憩室病晚期并发症仅占病例的18.1%。对于整个研究组，中转开腹率为7.2%。憩室炎较轻的患者（即表现为憩室周炎、狭窄或炎症反复发作的患者）中转开腹率为4.8%，复杂病例的中转开腹率为18.2%。在腹腔镜完成的手术中，282例患者中有3例死亡（1.1%）。在憩室周炎、狭窄或炎症反复发作的患者组中，总体并发症发生率为14.8%。Hinchey Ⅰ至Ⅳ期有穿孔性憩室炎的患者组或有瘘管和出血的患者组，相应的并发症发生率为28.9%，中转开腹后为31.8%。
乙状结肠憩室炎的腹腔镜结直肠手术大多是针对憩室周炎、狭窄或炎症反复发作而进行的择期手术。这些手术相关的中转开腹率、并发症发生率和死亡率是可以接受的。Hinchey Ⅰ至Ⅳ期乙状结肠憩室炎以及存在瘘管和出血情况下的腹腔镜手术更有可能出现并发症，且应仅由经验丰富的腹腔镜外科医生进行。
