Jones Oliver M, Stevenson Andrew R L, Clark David, Stitz Russell W, Lumley John W
Royal Brisbane Hospital, Herston, Australia.
Ann Surg. 2008 Dec;248(6):1092-7. doi: 10.1097/SLA.0b013e3181884923.
To examine morbidity, mortality, conversion rates, and disease recurrence after laparoscopic resection of complicated and uncomplicated diverticular disease in a single center.
In contrast to colorectal cancer, there are few large studies of laparoscopic or open resection for diverticular disease.
This study represents a retrospective analysis of a prospectively collected database of all laparoscopic resections for uncomplicated and complicated diverticulitis from a single center.
Five hundred patients (305 female) were identified (median age 58; range, 26-89). Recurrent diverticulitis was the most common indication for surgery (77%), followed by perforation (10%) and fistulation (9%). Median operating time was 120 minutes (range, 45-285) and median length of hospital stay was 4 (2-33) days. The splenic flexure was routinely mobilized. There was 1 (0.2%) 30-day and in-hospital death and 55 (11%) patients had major morbidity after the procedure. Conversion to an open operation was performed in 14 (2.8%) cases. Dense adhesions were the most common cause for conversion (6 patients). Among patients with complicated diverticulitis, the conversion rate was 5.3%, whereas for those with uncomplicated disease, it was 2.1% (P = ns). Operating time and length of hospital stay do not differ significantly between patients with complicated and uncomplicated diverticulitis. The conversion rate has come down from 8% for the first 100 cases to 1.5% for the last 400 cases (P = 0.002). To our knowledge, there have been no cases of recurrent diverticulitis.
Laparoscopic resection even in complicated cases of diverticulitis is safe and effective. It can be achieved with short operating times and length of stay in conjunction with very low rates of morbidity and mortality. Adherence to surgical principles including routine mobilization of the splenic flexure and anastomosis onto the rectum may explain the absence of disease recurrence in our experience.
在单一中心研究腹腔镜切除复杂性和非复杂性憩室病后的发病率、死亡率、中转率及疾病复发情况。
与结直肠癌不同，关于腹腔镜或开放手术治疗憩室病的大型研究较少。
本研究是对单一中心前瞻性收集的所有腹腔镜切除非复杂性和复杂性憩室炎数据库的回顾性分析。
共纳入500例患者（305例女性）（中位年龄58岁；范围26 - 89岁）。复发性憩室炎是最常见的手术指征（77%），其次是穿孔（10%）和瘘管形成（9%）。中位手术时间为120分钟（范围45 - 285分钟），中位住院时间为4（2 - 33）天。脾曲常规游离。有1例（0.2%）30天内及住院期间死亡，55例（11%）患者术后出现严重并发症。14例（2.8%）患者中转开腹手术。致密粘连是中转的最常见原因（6例）。在复杂性憩室炎患者中，中转率为5.3%，而在非复杂性疾病患者中为2.1%（P =无显著性差异）。复杂性和非复杂性憩室炎患者的手术时间和住院时间无显著差异。中转率从最初100例的8%降至最后400例的1.5%（P = 0.002）。据我们所知，尚无复发性憩室炎病例。
即使在复杂性憩室炎病例中，腹腔镜切除也是安全有效的。手术时间短、住院时间短，并发症和死亡率极低。遵循包括常规游离脾曲和直肠吻合在内的手术原则可能是我们经验中无疾病复发的原因。
