Trebuchet G, Lechaux D, Lecalve J L
Centre de Chirurgie Digestive, Hopital Pontchaillou, Rue Henri Le Guilloux, 35033 Rennes, France.
Surg Endosc. 2002 Jan;16(1):18-21. doi: 10.1007/s004640090122. Epub 2001 Oct 13.
The aim of this study was to review our experience with laparoscopic sigmoid colectomy for diverticular disease.
All patients presenting with acute or chronic diverticulitis, obstruction, abscess, or fistula were included. Symptomatic diverticular disease was the main surgical indication (95%).
Between March 1992 and August 1999 170 consecutive patients underwent surgery. Of these, 21 patients (12%) had significant obesity, with body mass index (BMI) greater than 30. The average length of surgery was 141 +/- 36 min. In 163 patients (96%), the procedure was performed solely with the laparoscope. The nasogastric tube was removed on postoperative day 2 +/- 1.9, and oral feeding was started on postoperative day 3.4 +/- 2.1. The average length of hospital stay after surgery was 8.5 +/- 3.7 days. During the first postoperative month, there were no deaths. However, 11 patients (6.5%) had surgical complications: 5 anastomotic leaks (2.9%), 1 intraabdominal abscess (0.6%), and 3 wound infections (1.7%). There were four reinterventions (2.4%), with two diverting colostomies. Secondarily, 10 anastomotic stenoses (5.9%) were observed. Eight patients required a reintervention: seven anastomotic resections by open laparotomy and one terminal colostomy. Seven patients (4.1%) reported retrograde ejaculation, and one reported impotence.
The feasibility of the laparoscopic approach to diverticular disease is established with a conversion rate of 4%, a low incidence of acute septic complications (5.3%), and a mortality rate of 0%. Therefore, laparoscopic sigmoid colectomy has become our procedure of choice in the treatment of diverticular disease.
本研究的目的是回顾我们在腹腔镜乙状结肠切除术治疗憩室病方面的经验。
纳入所有表现为急性或慢性憩室炎、梗阻、脓肿或瘘管的患者。有症状的憩室病是主要的手术指征（95%）。
1992年3月至1999年8月，连续170例患者接受了手术。其中，21例患者（12%）有明显肥胖，体重指数（BMI）大于30。平均手术时间为141±36分钟。163例患者（96%）仅通过腹腔镜进行手术。术后第2±1.9天拔除鼻胃管，术后第3.4±2.1天开始经口进食。术后平均住院时间为8.5±3.7天。术后第一个月内无死亡病例。然而，11例患者（6.5%）出现手术并发症：5例吻合口漏（2.9%），1例腹腔内脓肿（0.6%），3例伤口感染（1.7%）。有4例再次干预（2.4%），其中2例行转流性结肠造口术。其次，观察到10例吻合口狭窄（5.9%）。8例患者需要再次干预：7例通过开腹手术进行吻合口切除，1例行末端结肠造口术。7例患者（4.1%）报告逆行射精，1例报告阳痿。
腹腔镜治疗憩室病的可行性已得到证实，中转率为4%，急性感染性并发症发生率低（5.3%），死亡率为0%。因此，腹腔镜乙状结肠切除术已成为我们治疗憩室病的首选术式。
