Menenakos Evangelos, Hahnloser Dieter, Nassiopoulos Konstantinos, Chanson Christian, Sinclair Victoria, Petropoulos Panayiotis
Department of General Surgery, Hôpital Cantonal de Fribourg, Fribourg, Switzerland.
Langenbecks Arch Surg. 2003 Jul;388(3):189-93. doi: 10.1007/s00423-003-0392-4. Epub 2003 Jun 26.
Diverticular disease is complicated by colovesical and colovaginal fistulas in 4-20% of patients. Laparoscopic surgery is usually reserved for selected cases of uncomplicated disease. The aim of this study was to assess the efficacy and effectiveness of laparoscopic surgery in the treatment of those patients.
Eighteen patients, 15 with colovesical fistulas and three with colovaginal fistulas, were operated on laparoscopically. Prospectively collected data, associated with technical feasibility, short-term outcome and effectiveness, were analysed.
Twelve sigmoidectomies, four extended left colectomies and two segmentectomies were performed. Fistulas were treated with simple dissection or mechanical division, and the bladder wall was repaired in two patients. Mean operating time was 237 min (range 165-330). There was one conversion (5.5%) and no post-operative death. Morbidity was 27.7% and included one major complication. Return of gastrointestinal function occurred 2.9 days post-operatively, and the mean hospital stay was 10 days after surgery. During the 5.1-year follow-up period there was one fistula recurrence (5.5%) and no recurrent diverticulitis.
Laparoscopic one-stage surgery was technically feasible and safe, with low morbidity. Effectiveness appears favourable when compared with open surgery, but prospective randomized studies are necessary to support such a conclusion.
憩室病在4% - 20%的患者中会并发结肠膀胱瘘和结肠阴道瘘。腹腔镜手术通常仅用于部分无并发症的病例。本研究的目的是评估腹腔镜手术治疗这些患者的疗效和有效性。
对18例患者进行了腹腔镜手术，其中15例为结肠膀胱瘘，3例为结肠阴道瘘。对前瞻性收集的与技术可行性、短期结果和有效性相关的数据进行了分析。
实施了12例乙状结肠切除术、4例扩大左半结肠切除术和2例节段切除术。瘘管用简单分离或机械离断处理，2例患者修复了膀胱壁。平均手术时间为237分钟（范围165 - 330分钟）。有1例中转手术（5.5%），无术后死亡。发病率为27.7%，包括1例严重并发症。术后2.9天恢复胃肠功能，术后平均住院时间为10天。在5.1年的随访期内，有1例瘘复发（5.5%），无复发性憩室炎。
腹腔镜一期手术在技术上可行且安全，发病率低。与开放手术相比，有效性似乎较好，但需要前瞻性随机研究来支持这一结论。
