Mazza D, Chio' F, Khoury-Helou A
Service de chirurgie viscérale, centre hospitalier de Toulon, 1208, boulevard du colonel Picot, 83056 Toulon, France.
J Chir (Paris). 2009 Jun;146(3):265-9. doi: 10.1016/j.jchir.2009.06.014. Epub 2009 Jul 28.
To evaluate the results of a strategy of conservative laparoscopic treatment of peritonitis due to perforated diverticulitis for all patients, without exception for intraoperative findings or general patient condition, and to study the feasibility of eventual second-stage laparoscopic colectomy.
Between January 2003 and May 2007, 25 consecutive patients were urgently hospitalized with acute peritonitis due to perforated diverticulitis. All patients underwent laparoscopic peritoneal lavage and debridement; when there was a large perforation (ten cases), suture closure under laparoscopic control was performed. The Hinchey classification of peritonitis was Stage I in 2, Stage IIB in 8, Stage III in 9, and Stage IV in 6.
Postoperative morbidity occurred in 12% of cases. Mean operative time was 71 minutes. Conversion to open laparotomy was not required. Complications included residual abscess (drained percutaneously with CT guidance), urinary tract infection, and prolonged drainage via the drain tract. Mortality was zero. Mean hospital stay was 13.8 days. Sixteen patients (64%) subsequently underwent laparoscopic colectomy as a second stage procedure.
Conservative laparoscopic treatment of acute peritonitis due to perforated diverticulitis is a reliable alternative to open laparotomy in many cases; eventual laparoscopic colectomy at a subsequent stage is possible in the majority of patients.
评估对所有因穿孔性憩室炎导致腹膜炎的患者采用保守性腹腔镜治疗策略的结果，无论术中发现或患者一般状况如何，并研究二期腹腔镜结肠切除术的可行性。
2003年1月至2007年5月期间，连续25例因穿孔性憩室炎导致急性腹膜炎的患者紧急入院。所有患者均接受了腹腔镜下腹腔灌洗和清创术；当存在大穿孔时（10例），在腹腔镜控制下进行缝合关闭。腹膜炎的欣奇分类为I期2例，IIB期8例，III期9例，IV期6例。
术后发病率为12%。平均手术时间为71分钟。无需转为开腹手术。并发症包括残余脓肿（在CT引导下经皮引流）、尿路感染以及通过引流管延长引流时间。死亡率为零。平均住院时间为13.8天。16例患者（64%）随后作为二期手术接受了腹腔镜结肠切除术。
在许多情况下，对因穿孔性憩室炎导致的急性腹膜炎进行保守性腹腔镜治疗是开腹手术的可靠替代方法；大多数患者在随后阶段有可能接受二期腹腔镜结肠切除术。
