Tuech J J, Pessaux P, Rouge C, Regenet N, Bergamaschi R, Arnaud J P
Dept of Digestive Surgery, Angers University Hospital, 4 rue Larrey, 49000 Angers, France.
Surg Endosc. 2000 Nov;14(11):1031-3. doi: 10.1007/s004640000267.
The aim of this prospective comparative study was to assess the outcome of laparoscopic and open colectomy for sigmoid diverticulitis in patients aged >/=75 years.
From January 1993 to December 1998, all patients 75 years of age and older undergoing an elective colectomy for sigmoid diverticulitis were included in the study. The patients were divided into the following two groups: group 1 (n = 22) consisted of patients who underwent a laparoscopic procedure; group 2 (n = 24) consisted of patients who underwent an open procedure.
In group 1, there were 12 women and 10 men with a mean age of 77.2 years (range, 75-82); in group 2, there were 14 women and 10 men with a mean age of 78 years (range, 76-84) (p = 0.37). There was no difference between the groups in ASA classification. The operative time was shorter in group 2 (136 vs 234 mins). The postoperative period during which parenteral analgesics were required (5.4 vs 8.2 days, p = 0.001), postoperative morbidity (18% vs 50%, p = 0.02), postoperative length of hospital stay (13.1 vs 20.2 days, p = 0.003), and the inpatient rehabilitation (6 vs 15 patients, p = 0.01) were significantly shorter for group 1 than for group 2. There were no perioperative deaths. The conversion rate was 9% in group 1.
The data from the present study suggest that laparoscopic colectomy for sigmoid diverticulitis can be applied safely to older patients with fewer complication, less pain, shorter hospital stay, and a more rapid return to preoperative activity levels than that seen with open colorectal resection.
这项前瞻性对照研究的目的是评估年龄≥75岁的乙状结肠憩室炎患者行腹腔镜结肠切除术和开放结肠切除术的结果。
1993年1月至1998年12月，所有75岁及以上因乙状结肠憩室炎接受择期结肠切除术的患者均纳入本研究。患者分为以下两组：第1组（n = 22）为接受腹腔镜手术的患者；第2组（n = 24）为接受开放手术的患者。
第1组有12名女性和10名男性，平均年龄77.2岁（范围75 - 82岁）；第2组有14名女性和10名男性，平均年龄78岁（范围76 - 84岁）（p = 0.37）。两组在ASA分级方面无差异。第2组手术时间较短（136分钟对234分钟）。第1组需要胃肠外镇痛药的术后时间（5.4天对8.2天，p = 0.001）、术后发病率（18%对50%，p = 0.02）、术后住院时间（13.1天对20.2天，p = 0.003）以及住院康复情况（6名对15名患者，p = 0.01）均显著短于第2组。无围手术期死亡病例。第1组的中转率为9%。
本研究数据表明，乙状结肠憩室炎的腹腔镜结肠切除术可安全应用于老年患者，与开放结直肠切除术相比，并发症更少、疼痛减轻、住院时间缩短且能更快恢复到术前活动水平。
