Vargas H D, Ramirez R T, Hoffman G C, Hubbard G W, Gould R J, Wohlgemuth S D, Ruffin W K, Hatter J E, Kolm P
Norfolk Surgical Group, Ltd., and the Department of Surgery, Eastern Virginia Medical School, USA.
Dis Colon Rectum. 2000 Dec;43(12):1726-31. doi: 10.1007/BF02236858.
The purpose of this study was to evaluate the safety and efficacy of laparoscopic-assisted sigmoid colectomy for the treatment of diverticulitis.
The Norfolk Surgical Group Laparoscopic Surgery Registry identified all patients undergoing laparoscopic colon and rectal surgery. Retrospective chart review was performed for all patients undergoing elective sigmoid resection for a final diagnosis of diverticulitis and minimum follow-up of 12 months. Demographic data, indications for surgery, operative data, conversion rate, reason for conversion, complications, postoperative course (days to flatus and regular diet), and length of stay were identified. A telephone survey determined the incidence of recurrent diverticulitis. Statistical analysis was performed to evaluate the frequency of conversion over time, to determine risk factors for conversion, and to compare the laparoscopic-assisted and conversion groups with regard to postoperative days to flatus, regular diet, and discharge.
From June 1992 to September 1997, elective laparoscopic-assisted sigmoid colectomy was attempted in 69 patients. Uncomplicated recurrent diverticulitis was the most common indication for surgery, occurring in 51 of 69 patients (75 percent). No deaths occurred. Complications were identified in seven patients (10.1 percent) including one wound infection and one incarcerated port-site hernia with small bowel obstruction. There were no anastomotic leaks or major septic complications. Conversion to laparotomy occurred in 18 of 69 patients (26 percent). Uncomplicated, recurrent diverticulitis was associated with conversion in 7 of 51 patients (14 percent), whereas complicated diverticulitis required conversion in 11 of 18 patients (61 percent). Logistic regression identified fistula and abscess as predictors of conversion (P = 0.0009). Comparison of the laparoscopic-assisted sigmoid colectomy group with the conversion group revealed that postoperative days to regular diet were 3.5 and 5.2 (P = 0.0004), respectively, and lengths of stay were 4.2 and 6.4 days (P < 0.0001), respectively. No difference was noted with regard to operative time or postoperative complications. Median follow-up was 48 (range, 13-76) months, and a single recurrence of diverticulitis has been identified.
Laparoscopic-assisted sigmoid colectomy for diverticulitis can be safely performed. Conversion appears to be associated with complicated diverticulitis (fistula or abscess), which may be better approached by laparotomy. Short-term follow-up indicates that recurrence is rare and suggests that laparoscopic-assisted sigmoid colectomy achieves adequate resection. Laparoscopic-assisted sigmoid colectomy offers benefits of decreased ileus and length of stay and may represent the procedure of choice for elective resection for uncomplicated sigmoid diverticulitis.
本研究旨在评估腹腔镜辅助乙状结肠切除术治疗憩室炎的安全性和有效性。
诺福克外科组腹腔镜手术登记处确定了所有接受腹腔镜结肠和直肠手术的患者。对所有因最终诊断为憩室炎而接受择期乙状结肠切除术且至少随访12个月的患者进行回顾性病历审查。确定人口统计学数据、手术指征、手术数据、中转率、中转原因、并发症、术后病程（排气和恢复正常饮食的天数）以及住院时间。通过电话调查确定复发性憩室炎的发生率。进行统计分析以评估随时间推移的中转频率，确定中转的危险因素，并比较腹腔镜辅助组和中转组在术后排气、恢复正常饮食及出院天数方面的情况。
1992年6月至1997年9月，69例患者尝试了择期腹腔镜辅助乙状结肠切除术。无并发症的复发性憩室炎是最常见的手术指征，69例患者中有51例（75%）出现。无死亡病例。7例患者（10.1%）出现并发症，包括1例伤口感染和1例嵌顿性切口疝伴小肠梗阻。无吻合口漏或严重感染并发症。69例患者中有18例（26%）中转开腹手术。51例无并发症的复发性憩室炎患者中有7例（14%）中转，而18例复杂性憩室炎患者中有11例（61%）需要中转。逻辑回归分析确定瘘管和脓肿是中转的预测因素（P = 0.0009）。腹腔镜辅助乙状结肠切除术组与中转组比较显示，术后恢复正常饮食的天数分别为3.5天和5.2天（P = 0.0004），住院时间分别为4.2天和6.4天（P < 0.0001）。手术时间或术后并发症方面未发现差异。中位随访时间为48（范围13 - 76）个月，已发现1例憩室炎复发。
腹腔镜辅助乙状结肠切除术治疗憩室炎可安全实施。中转似乎与复杂性憩室炎（瘘管或脓肿）相关，开腹手术可能更适合处理此类情况。短期随访表明复发罕见，提示腹腔镜辅助乙状结肠切除术可实现充分切除。腹腔镜辅助乙状结肠切除术具有减少肠梗阻和缩短住院时间的优点，并可能成为择期切除无并发症乙状结肠憩室炎的首选术式。
