Reissfelder Christoph, Buhr Heinz J, Ritz Joerg-P
Department of General, Vascular and Thoracic Surgery, Charité-General Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
Dis Colon Rectum. 2006 Dec;49(12):1842-8. doi: 10.1007/s10350-006-0730-z.
This prospective study was designed to check the ideal time of surgical intervention by comparing the results of early elective laparoscopic sigmoid resection after an inflammatory attack with those of late elective resection during the inflammation-free interval.
A total of 210 patients (114 males) underwent laparoscopic resection for acute sigmoid diverticulitis between 1999 and 2005. They were prospectively divided into two groups: Group I with an early elective sigmoid resection (5-8 days after initial antibiotic treatment); Group II in the inflammation-free interval (4-6 weeks after initial hospitalization).
There was no difference between the groups with regard to age (55.7 years), American Society of Anesthesiologists score (1.86), previous diseases, and extent of inflammation. After surgery, 156 patients (74.3 percent) were complication-free. There was a total of ten conversions (Group I, 9; Group II, 1; P<0.05). Minor complications developed in 42 patients (abdominal wall abscess=24, intestinal atony=6, hematoma=9, urinary tract infection=2). Eight patients in Group I (P<0.05) developed anastomotic leaks. None of the patients died.
In the majority of patients, laparoscopic sigmoid resection in sigmoid diverticulitis can be performed without conversion. Patients who underwent surgery in the inflammation-free interval had a lower complication rate than those submitted to early elective resection. In our patient population, we were able to show that surgery in the inflammation-free interval significantly reduces postoperative morbidity. It is thus preferable for patients with sigmoid diverticulitis to receive initial antibiotic treatment and then undergo late elective laparoscopic sigmoid resection.
本前瞻性研究旨在通过比较炎症发作后早期选择性腹腔镜乙状结肠切除术与炎症消退期晚期选择性切除术的结果，来确定手术干预的理想时机。
1999年至2005年间，共有210例患者（114例男性）接受了急性乙状结肠憩室炎的腹腔镜切除术。他们被前瞻性地分为两组：第一组为早期选择性乙状结肠切除术（初始抗生素治疗后5 - 8天）；第二组为炎症消退期（初次住院后4 - 6周）。
两组在年龄（55.7岁）、美国麻醉医师协会评分（1.86）、既往疾病及炎症程度方面无差异。术后，156例患者（74.3%）无并发症。共有10例中转手术（第一组9例；第二组1例；P<0.05）。42例患者出现轻微并发症（腹壁脓肿24例、肠麻痹6例、血肿9例、尿路感染2例）。第一组有8例患者（P<0.05）发生吻合口漏。无患者死亡。
大多数患者行腹腔镜乙状结肠憩室切除术无需中转。在炎症消退期接受手术的患者并发症发生率低于早期选择性切除术患者。在我们的患者群体中，我们能够证明在炎症消退期进行手术可显著降低术后发病率。因此，乙状结肠憩室炎患者最好先接受初始抗生素治疗，然后进行晚期选择性腹腔镜乙状结肠切除术。
